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Presented  by 
Maurice  F.  Decker,   D.   0. 


COLLEGE  OF  OSTEOPATHIC  PHYSICIANS 
AND  SURGEONS  •  LOS  ANGELES,  CALIFORNIA 


&WW^TWTirritr7Tt7r!i^^^ 


4v:V/*- 


Digitized  by  tine  Internet  Arciiive 

in  2007  witii  funding  from 

IVIicrosoft  Corporation 


littp://www.archive.org/details/causescurativetrOOgardiala 


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I'l.M'h:  I. 


T.-Smclairs  Chromo  lith,Phil* 


CAUSES  AND  CURATIVE  TREATMENT 
o» 

STERILITY, 

WITH    A 

PRELIMINARY  STATEMENT 

OF    THE 

PHYSIOLOGY  OF  GEIERATION 

22ti:l^  Colowb  ^itljograp^s  anb  ^umcroas  ^oob  Cut  |Uustratioirs. 

I         BY 

AUGUSTUS  K.  ^AKDNER,  A.M.,  M.D., 

PIBMANEKT  MEMBER   OF  THE  NATIONAL  MEDICAL   ASSOCIATION  ;    FELLOW  OF  THE   NEW   TOKX 

ACADEMY    OF    MEDICINE  ;    MEMBER  OF  THE   MASSACBDSETTS   MEDICAL  SOCIETf  ; 

MEMBER  OF  THE  NEW    YORK   PATHOLOGICAL  SOCIETY  ;    LATE   INSTRUCTOR 

ON   DISEASES  OF   WOMEN   AND   CHILDREN   IN   THE  NEW   YORK 

PREPARATORY    SCHOOL    OF     MEDICINE  ; 

PHT8ICIAN  FOR  DISEASES  OF   WOMEN,    IN  THE   NEW   YORK   NORTHERN  DISPKN3ABT ; 

AUTHOR  OF   MONOGRAPHS  ON   ERGOT,    UTERINE   HEMORRHAGE, 

RUPTURE  OF  THE  PERINEUM,   ETC.,  ETC. 


NEW    YORK: 
DE  WITT   &   DAVENPORT,  PUBLISHERS, 

160   &   162  NASSAU  STREET. 


\AJp570 

Gr  >^  P-  Co  c 

I  ?5U 


EimsiD  according  io  Act  of  CoogrcM,  in  Ok*  yew  ISK,  bj 

DK  WITT  k  DAVENPORT, 

In  the  aerk't  Office  of  the  District  Court  of  the  U.  S.  for  the  Southern  Dutrict  of  Kew  York. 


W.  H.  TimoK,  Stercotypcr.  GsoBSS  Rumu  &  Co.,  Piinten.  6.  W.  Alexander,  Binder, 


KOT   TO    THE    INVENTOR    OF   THE 
CLAMP    SUTURE, 

THK     CROWNING     SURGICAL    APPLIANCE     OF     THE     AGE; 

NOR   TO   THE    PHILANTHROPIC    PROJECTOR    OF    THE 

WOMAN'S    HOSPITAL, 

THB   NOBLEST    CHARITY    OF   THE    NINETEENTH"   CENTURY; 

BUT   TO    THE   MAN    OF   PRIVATE   WORTH,   TO 

J.  MARION  SmS,    M.D., 

THIS     VOLUME     IS     DEDICATED, 

AS     A    TOKEN    OF    THE     PERSONAL    FRIENDSHIP 

AND    PROFESSIONAL   ESTEEM    OF 

THE  AUTHOR. 


?  PREFACE. 


-i 


a 


Fob  many  years  my  attention  has  been  almost  undividedly 
given  to  the  treatment  of  the  various  diseases  peculiar  to 
women,  to  parturition,  and  to  its  accompanying  and  succeeding 
maladies.  From  the  many  thousand  cases  in  hospital  and 
private  practice,  which  have  fallen  under  my  observation,  I 
have  gathered  experience,  and,  insensibly  to  myself,  I  have 

9  also  formed  opinions,  which  have  grown,  strengthened,  and 
been  verified  by  every  day's  labors.     The  result,  in  relation  to 

/     one  affection  only,  I  propose  to  give  in  this  treatise. 

^  Impotency  and  Sterility  are  the  names  given  to  that  condi- 
L--  tion  of  the  sexes  which  makes  a  childless  bed  and  matrimonial 
discords,  which  have  changed  the  fate  of  nations,  and  the 
destiny  of  the  world.  Occasionally  these  conditions  arise  from 
a  defect  in  the  provisions  of  nature,  almost  always,  however, 
are  the  consequences  of  disease.   Sometimes  the  difficulties  have 

'^  been  suffered  to  continue  unchecked,  till  organic  changes  are 
effected,  which  can  never  be  palliated.  In  the  vast  majority 
of  cases,  not  only  can  they  be  alleviated,  but  the  disorders  can 
be  entirely  removed,  and  a  most  joyous  result  will  not  only 
bring  proof  of  the  cure,  but  will  be 

••  A  baby  in  the  house,  a  well-spring  of  pleasure." 

0 


J?S^70 


VI  PREFACE. 

Impotency  is  the  affection  of  the  male  parent,  and  will  not 
be  treated  in  this  work.  Sterility,  or  the  barrenness  of  the 
female,  its  almost  universal  local  cause,  the  means  and 
certainty  of  its  cure,  will  occupy  the  following  pages.  If  the 
undoubted  facts  of  my  own  experience,  and  the  gathered 
wisdom  of  those  of  the  past  and  present  time,  who  have  given 
their  attention  to  this  subject,  shall  be  stated  with  clearness 
and  force  sufficient  to  convince  the  practitioners  of  medicine 
in  this  country — ^who  are  the  depositaries  of  the  secrets  of  so 
many  families — and  thus  enable  them  to  hold  out  a  remedy  for 
this  gnawing  worm  in  the  bud  of  happiness,  the  purpose  of 
this  treatise  will  be  effected. 

Niw  YoKK,  141  East  Thibteenth  Si^, 
May  l«t.,  1856. 


CONTENTS. 


INTRODUCTION. 


PAQB 


Harmony  of  nature  in  its  anatomical  formations — Identity  of  the  reproduc- 
tive  functions — The  greatness  of  the  divine  Creator  manifested  in  all  his 
works — What  human  energy  has  discovered — How  animal  life  ia  perpetu* 
ated — Beasons  for  entering  upon  the  physiology  of  generation  ...      10 

L 

PHYSIOLOGY   OF   GENERATION. 

In  what  reproduction  consists — Fecundation  in  plants  and  fish — Natural  and 
artificial — Stated  times  of  impregnation  in  animals  and  women — That  the 
woman  who  menstruates  is  capable  of  being  fecundated — Identity  of 
fecundation  in  all  animal  life — Theory  of  producing  sexes  at  will — Propor- 
tion of  male  to  female  births — Description  of  the  ovum — Male  life  princi- 
ple— The  female  organs  of  reproduction  —  Their  functions — Manner  of 
menstruation — Character  of  the  discharge — The  human  egg — Anatomy  of 
egg — Secretions  of  female  genital  organs — Epitome  of  the  "  cell  theory"  of 
growth  and  reproduction — Man  in  his  first  estate — Semen — Its  compoffl- 
tion — Germinating  and  fertilizing  vesicles — Development  of  Spermatozoa 
— not  animalcules — Manner  of  union  of  the  male  and  female  life-giving 
principle — Action  of  uterus  in  congress — Why  women  raped  are  rarely 
fecundated — Direct  passage  from  the  vagina  to  the  ovaries — BischofiTs  and 
others'  views — Passage  of  ovum — Distinctive  duties  of  the  divisions  of  the 
germ  vesicle — Growth  of  development  ceases  and  the  growth  of  augmen- 
tation commences •••14 

n. 

PATHOLOGY    OF    STERILITY. 

Fecundation — How  ensured — Circumstances  preventing — Affections  of  thb 
VAGINA — Novel  cases  in  law — Impotence  of  male  from  malformations, 
disease,  &c. — Virility  at  advanced  age — Effects  of  various  vaginal  dis- 
charges— Various  appearance  of  hymen — Constriction  of,  and  strictures  in 


Viii  CONTENTS. 


the  vagina — Prolapsus,  malpositions,  flexions  and  versions  of  uterus — 
Affkctions  of  OS  AND  CKRVix  UTKRi — Poljpi  of  uterus — Ovulffi  nabothii 
— Value  of  the  speculum  in  diagnosis — Diseases  of  the  os  and  cervix,  the 
analogue  of  various  skin-diseases  —  A  scrofulous  diathesis  having  a 
marked  tendency  to  uterine  disease,  also  to  fecundation— Uterine  disease 
estabUshed,  rarely  disappearing  spontaneously — ImpossibiUty  of  the  aged 
sense  being  taught — Symptoms  of  uterine  disease — Leucorrhoea — Char- 
acter of  vaginal  discharges — Cause  of  death  of  spermatozoa — Falling  of 
the  womb  —  Raspberry  os  —  Leucorrhoea  an  evidence  of  a  strumous 
diathesis — Fissures  of  os  uteri — Speculum  os  uteri — Effects  of  inordinate 
sexual  intercourse — Diseases  of  cavity  of  the  uterus — Uterus  ossified 
—  Metritis  —  Diseases  of  the  fallofiai*  tubes — Stricture  —  Rupture — 
ObUteration — Disease  of  fimbriated  extremity — Disease,  deformity  or 
misplacement  of — Polypi — Disease  of  ovary — Tumors  in  and  around — 
Hernia  of,  absence  of,  atrophy — Inflammation  acute  and  chronic — Rheu- 
matism and  neuralgia  of  uterus  and  appendages — Influence  of  fatness  as 
CAUsiNO  sterility — "Frec-martins" — The  female  of  male  and  female  twins, 
barren — Character  of  those  malformed  in  the  genital  organs — General  attri- 
butes— Mental  manifestations  of  the  diseased — Absence  of  sexual  appetites 
from  over  stimulation,  venereal  excesses,  masturbation,  &c. — ^Effects  of 
constitutional  syphilis,  mercurialization,  &c 58 

m. 

THERAPEUTICS    OF    STERILITY. 

Treatment  and  cure  sometimes  synonymous — Requisites  for  fecundation — 
Instance  of  precocity  —  Operations  on  hymen — Strictures  of  vagina 
treated — Sensitiveness  of  vagina  from  urethral  tumors,  relieved  by  local 
anaesthetics — Removal  of  urethral  tumors  by  knife,  ligature,  cautery— 
Eversion  of  the  uterua  treated  by  Simpson's  uterine  supporter — Effects 
of  constipation — Polypi — Various  modes  of  treatment — excision,  torsion, 
caustics,  curette — Little  danger  of  haemorrhage  from — Removal  by  Chas- 
saignac's  ^crasseur — By  galvanism — Hydatids — How  removed — New  form 
of  speculum — Ulcerations  treated  by  local  injections  of  cold  water — 
Infusions  of  tannin  —  Caustic  applications — alteratives — Sexual  inter- 
course not  necessarily  interrupted — Scarifications  in  hypertrophy — Excis- 
ions of  OS  uteri — Issues  upon  os  uteri — Leeches  and  their  danger — Stric- 
ture of  cervix,  and  fissures  of  os — Lacerations  of  os  and  cervix — Dysmen- 
orrhoea — Instrument  for  division  of  strictures — Sponge  Tents — Difficulty 
in  using  sounds — Anatomical  formation  of  the  interior  of  the  cervix — 
Catarrh  of  the  womb — Treatment  by  injections — Dangers  of — Oblitera- 
tion of  the  cavity  of  the  uterus — Probing  fallopian  tube — Treatment 
for  affections  of  the  ovary^-excessive  fat — Torpor  of  uterine  system — 
Application  of  electricity — Syphilitic  taint — Sobriety  of  body  and  mind 
recommended 114 

Authorities  cited 105 


THE 


CAUSES   AND    CURATIVE    TREATMENT 


OF 


STERILITY. 


INTRODUCTION. 

The  economy  and  harmonious  beauty  of  nature  are 
nowhere  more  manifest  than  in  the  arrangement  and 
operation  of  its  reproductive  organs.  This  is  in 
accordance  with  the  same  disposition  respecting  the 
other  organs.  Take,  for  instance,  the  skeletons  of  the 
various  creatures  in  animated  nature — they  have  all 
one  general  type,  and  it  is  easy  to  note  the  resemblance. 
To  create  a  bird,  an  animal,  and  man,  nature  did  not 
construct  three  distinct  forms,  but  modified  this  general 
type.  The  necks  of  the  elephant,  of  the  giraffe,  of  the 
owl,  the  goose,  the  fish,  of  man,  are  but  varieties  of 


1 0  INTRODUCTION. 

the  same  conformation,  diverse  as  they  may  appear. 
The  arm  of  the  man,  the  fin  of  the  fish,  and  the  wing 
of  the  bird  are  formed  upon  the  same  model.  In  each 
may  be  found  the  {scapula)  shoulder-blade  ;  the  {clavicle) 
collar-bone  ;  the  {humerus)  single  bone  of  the  arm ;  the 
{radius  and  ulna)  double  bones  of  the  fore-arm,  with 
the  bones  of  the  wrist  and  hand  more  or  less  fully 
developed.  Each,  according  to  the  duties  required,  is 
magnified  or  diminished.  The  clavicle  of  the  man 
bears  a  very  small  proportion  to  that  of  the  duck,  and 
the  wing  of  the  flying-fish  is  but  an  hypertrophy  of  the 
fin  of  the  ordinary  fish,  in  itself  a  modification  of  the 
human  hand. 

To  the  careless  observer,  the  ponderous  shoulder 
and  the  short  fore-leg  of  the  patient,  slow-moving 
ox  have  little  to  remind  him  of  the  light,  slender, 
rapid-moving  arm  of  the  monkey.  The  student  of 
comparative  anatomy,  however,  speedily  discovers  their 
identity. 

In  the  same  manner,  the  organs  concerned  in  the- 
reproductive  functions  are  identical.  In  every  living 
thing  there  are  the  male  and  female  structures,  in  a  more 
or  less  developed  condition.  In  every  genus  and  species 
of  sentient  life,  the  new  being  is  reproduced  from  an 
egg,  the  creation  of  a  former  parent. 

For  several  reasons  we  shall  endeavor  to  make  this 
abstruse  matter  plain.  First,  because  it  adds  another 
cause  of  wonder  at  the  greatness  and  power  of  the 


INTRODUCTION.  11 

divine  Architect  of  creation  ;  it  shows,  not  how  great  is 
God,  but  how  small  is  man.  Dr.  Young  once  said 
that  "  an  undevout  astronomer  is  mad  ;"  with  greater 
emphasis  it  might  be  proclaimed,  that  a  doubting 
anatomist  was  devoid  of  reason.  It  would  seem  as  if 
man  could  not  look  down  upon  man,  either  as  a  whole, 
or  in  his  apparently  as  wonderful  integral  portions, 
without  being  overwhelmed  with  the  stupendous 
greatness  of  the  Creator  of  all  things. 

Secondly — The  method  by  which  growth  is  eflfected; 
and  still  more,  the  manner  in  which  a  new  creation  is 
formed,  is  one  that  interests  every  person  of  whatever 
faculties  or  education.  All  men  are  curious  by  nature. 
They  love  to  look  into  the  interiors  of  even  man's  feeble 
constructions.  The  child  seeks  to  discover  the  motive 
power  in  the  watch  ;  and  man,  but  an  older  child,  gazes 
at  the  movements  of  the  steam  engine  and  the  spinning- 
jenny.  A  step  higher,  and  the  loftiest  intellects  of 
earth  have  spent  their  lives  in  analyzing  the  material 
body  of  man,  in  speculating  upon  his  mental  attributes, 
and  in  developing  the  hidden  mysteries  of  his  double 
nature. 

Human  energy  has  done  something.  It  has  discovered 
how  we  breathe,  and  the  office  of  respiration  ;  why  we 
inhale  air  ;  why  we  expire  it ;  what  effect  is  produced 
thereby.  It  has  discovered  how  the  food  is  masti- 
cated, comminuted,  changed  to  chyle,  taken  up  by  the 
absorbents,  poured  into  the  impure  blood,  purified  in  the 


12  INTRODUCTION. 

lungs,  and  its  subsequent  office.  The  formation,  cir- 
culation, and  intention  of  the  blood  are  known.  Science 
has  carried  this  subject  through  from  the  beginning 
to  the  end.  In  other  directions,  science  has  made  less  ' 
progress — we  know  that  the  brain  is  the  organ  whence 
thought,  sensation,  and  character  proceed,  but  we  know 
little  of  its  methods  of  working. 

The  method  whereby  the  various  genera  and  species 
of  life  are  perpetuated,  is  another  branch  of  human 
inquiry,  of  which  our  knowledge  is  limited.  Still, 
upon  this  point  we  are  not  entirely  ignorant ;  but, 
notwithstanding  the  almost  irrepressible  desire  of  the 
human  being  to  know  somewhat  on  this  topic,  a  false 
sense  of  propriety  has  attempted  to  ignore  this  subject, 
and  the  ardent  investigator  has  been  compelled  to  turn 
to  the  fanciful  statements  of  ignorant  and  credulous 
pretenders  to  science,  to  satisfy  his  cravings  for 
knowledge.  This  subject  is,  therefore,  here  enlarged 
•upon,  because  there  is  no  treatise  in  our  language 
upon  this  subject,  which  gives  a  correct  statement 
of  the  knowledge  of  this  century,  and  of  the  present 
decade. 

Thirdly — ^It  is  necessary,  for  the  purposes  laid  out  in 
the  design  of  this  work,  to  state  in  what  nature  consists, 
that  the  deviations  from  nature  may  be  made  clear  and 
palpable  to  the  intelligent  understanding,  for  without 
both  of  these  points  being  lucidly  perceptible,  the  means 
here  proposed  for  the  correction  of  these  deviations  will 


INTRODUCTION.  13 

not  be  firmly  impressed  upon  the  mind.  In  other  words, 
unless  the  reader  fully  knows  what  is  health,  and  what 
disease,  he  cannot  understandingly  perceive  what  is  the 
remedy  and  why  its  potency. 


14  PHYSIOLOGY   OF   GENERATION. 


I. 

PHYSIOLOGY   OF   GENERATION. 

Following  the  same  laws  shown  in  the  development 
of  the  different  forms  of  animated  nature,  the 
reproduction  of  the  species  is  effected  in  the  same 
manner  throughout  creation.  Reproduction  consists 
in  the  growth  of  an  ovum,  egg,  germ,  seed,  or  embryo 
in  a  living  part,  from  which  it  is  separated  when 
capable  of  independent  existence.  The  females  of 
plants  and  animals  supply  the  germ,  while  the  male 
affords  a  fructifying  fluid. 

In  plants  the  existence  of  distinct  sexes  is  well 
known,  and  the  method  of  their  union  and  their 
fecundation,  by  means  of  the  pollen,  has  long  been 
observed,  and  horticulturists  have  availed  themselves  of 
this  knowledge  to  raise  varieties  of  fruit  at  their  option ; 
aU  that  is  necessary  being  to  shake  a  blooming  branch 
of  the  male  over  the  flowers  of  the  female. 

The  same  thing  is  now  being  effected  in  this  country 
with  the  fish  tribe,  after  the  plan  of  Mons.  Coste,  the 
distinguished  embryologist  of  the  College  of  France, 
Paris. 


ARTIFICIAL    FECUNDATION.  15 

The  fecundation  of  the  fish  ovum  is  almost  as  free  as 
the  seed  of  the  plant.  The  female  deposits  her  eggs, 
and  the  male  finding  them,  ejects  the  fructifying 
principle,  pertaining  to  his  sex,  upon  them  ;  both 
leaving  them  afterwards  to  chance.  Mons.  Coste 
discovered  that  by  taking  the  female,  and  by  gently 
pressing,  he  could  cause  the  eggs  to  be  discharged  into 
a  vessel  prepared  for  the  purpose,  and  that  by  treating 
the  male  in  a  similar  manner,  the  seminal  principle  was 
also  discharged.  Then  by  gently  shaking  them  together, 
placing  them  in  proper  situations,  the  egg  was 
fecundated,  and  innumerable  fish  were  thus  propagated. 

In  the  higher  types  of  animal  life  fecundation  is  not 
so  easily  effected,  but  throughout  all  nature,  the 
essential  principle  is  the  same.  The  female  furnishes 
the  germ,  egg,  embryo. 

In  the  female  of  most,  if  not  all  animals,  this 
germ  is  afforded  only  at  periods  of  greater  or  less 
intermediate  intervals.  In  the  greater  animals,  the 
horse,  cow,  deer,  elephant,  camel,  many  birds,  this  period 
occurs  but  once  a  year  ;  with  the  cat  and  dog  species, 
twice  or  three  times,  and  with  the  rabbit  and  domestic 
fowl,  it  is  much  more  frequent.  This  season  is  termedl 
time  of  heat,  rutting  period,  &c. 

With  the  human  female,  the  general  opinion  has 
been  that  there  was  no  particular  period,  which  is 
unquestionably  an  error.  It  is  almost  demonstrated 
that  the  woman  is  never  impregnated,  except  for  a 


16  PHYSIOLOGY   OF   GENERATION. 

short  season  immediately  subsequent  to  her  menstrual 
discharge.  That  they  are  more  apt  to  conceive  at 
this  period,  was  noted  so  long  ago  as  the  life-time  of 
Pliny,  who,  in  his  Zoology,  says:  "Conception  is 
generally  said  to  take  place  most  readily  either  at  the 
beginning  or  the  end  of  the  menstrual  discharge  ;"  and 
we  are  informed  by  the  French  historians  * '  that  their 
king,  Henry  II.,  and  his  wife,  Catherine,  having 
been  childless  eleven  years,  made  a  successful 
experiment  by  the  advice  of  their  physician,  Fernel ; 
intercourse  immediately  after  the  cessation  of  the  peri- 
odical discharge,  proving  fruitful." — Lemaire,  vol.  iii., 
p.  83,  also  William  Harvey  in  1651,  in  his  work 
"  On  Birth  and  Conceptions^''  says  :  "Wherefore,  their 
terms  being  now  at  hand,  or  nearly  over,  whilst  the 
warmth  and  moisture  of  the  part  (which  are  the 
necessary  causes  of  generation)  do  remain,  women  are 
most  apt  to  conceive." 

Says  Pouchet  (in  his  "  The.orie  Positive  de 
VOvulation  Spontanze,  Paris,  1847,  p.  274,  275),  "But 
as  we  have  recognized  that  the  decidua  always  is 
destroyed  from  the  tenth  to  the  twelfth  day  of  men- 
struation, it  consequently  results  therefrom,  that  con- 
ception cannot  take  place  except  during  the  ten  days 
subsequent  to  the  appearance  of  menstruation,  and  that 
it  can  never  take  place  after  this  epoch."  Bischoflf, 
Courty,  and  other  eminent  physiologists,  recognize  this 
statement  as  correct.     The  occasional  exceptions  when 


TIME    FOR   CONCEPTION.  17 

pregnancy  occurs  later,  are  accounted  for  in  some  other 
satisfactory  manner,  which  has  been  alluded  to  in 
another  place.  Certain  it  is,  however,  that  in  the  vast 
majority  of  cases,  conception  takes  place  only  after 
menstruation,  although  the  length  of  this  period  is  vari- 
ously prolonged.  This  season  is  in  almost  every  respect 
analogous  to  the  heat  of  animals.  The  outward  signs 
are  distinctly  perceptible.  The  bitch  in  heat  has  the 
genitals  tumefied  itJjd  reddened,  and  a  bloody  discharge. 
The  human  female  has  nearly  the  same  ;  and  although 
she  may  possess  sensual  appetites  at  other  periods,  they 
are  notoriously  heightened,  somewhat  anteriorly,  and 
very  manifestly  immediately  subsequent  to  this  epoch. 
Of  this  fact  I  am  fully  convinced  from  the  testimony  of 
very  many  females  who  have  replied  to  my  questions, 
asked  of  them  in  order  to  elicit  the  fkcts  upon  which  I 
have  based  the  theory  enunciated  in  this  treatise. 

A  medical  army  officer,  according  to  the  Am.  Med. 
Monthly,  says  :  "  The  Indians  of  Puget  Sound  have  a 
season  of  amorousness  affecting  both  sexes — from  May 
to  October,  most  active  in  June — corresponding  with 
the  salmon-eating  season.  The  remainder  of  the  year 
they  are  cold  and  without  passion." 

It  is  from  a  generally  wide-spread  error  upon  this 
point  that  it  is  deemed  necessary  to  insist  with  some 
earnestness  upon  this  particular.  The  tables  compiled 
by  Churchill  and  others,  in  order  to  determine  the  time 
of  the  duration  of  gestation,  also  prove  this  fact,  which 

2 


18  PHYSIOLOGY    OF    GENERATION. 

will  hereafter  be  more  fully  alluded  to.  The  point  to 
be  borne  in  mind  is,  that  the  human  female  is  capable 
of  being  impregnated  only  for  a  few  days  every  four 
weeks,  subsequent  to  her  usual  menstrual  periods. 

One  fact  should  be  most  particularly  noted,  that  the 
regular  monthly  bloody  flow  is  always  excited  by  the 
■discharge  of  an  ovum — that  no  other  hemorrhage  ever 
occurs  periodically — and  as  a  consequence,  which  admits 
of  no  exception,  every  woman  who  regularly  menstruates 
is  capable  of  being  fecundated  under  certain  conditions. 

The  fecundation  of  the  ovum  in  accordance  with  the 
providence  of  nature,  is  the  same  with  all  animated 
creation.  It  is  simply  the  union  of  the  male -vivifying 
principle  with  the  ovum  of  the  female,  in  a  proper  and 
natural  situation. 

In  the  allusion  already  made  to  the  procreation  of 
.fish,  all  that  was  done  was  in  accordance  with  this 
statement.  The  ovum  of  the  fish  in  water  was  mixed 
with  the  seminal  principle,  of  the  male  ;  both  being 
in  a  sound  physiological  condition.  All  that  was 
unnatural  was  the  manner  in  which  the  union  was 
. effected,  and  this,  as  will  be  seen,  is  unimportant. 

Dr.  Silas  Hibbard  of  New  Hampshire,  has  recently 
advanced  the  theory  in  the  Buffalo  Medical  Journal, 
Sept.  1850,  that  males  are  conceived  shortly  before  the 


SEXES    AT    WILL.  W 

time  of  the  courses,  and  females  after.  The  theory  is, 
that  there  is  generally  a  periodical  development  and 
-maturation  of  an  ovum  near  the  time  of  the  courses, 
and  that  said  maturation  usually  bears  the  same  relation 
to  the  time  of  the  courses  in  all  women,  and  thus  they 
are  ordinarily  more  susceptible  of  impregnation  shortly 
before  and  shortly  after  menstruation,  and  also  that  this 
susceptibility  is  nearly  equal  at  both  these  times.  His 
theory  further  is,  that  the  same  ovum,  if  fecundated 
shortly  before  the  courses,  will  generally  grow  to  be  a 
male,  while  if  fecundation  is  deferred  till  after  the 
courses,  it  will  generally  grow  to  be  a  female. 

Apart  from  the  very  loose  and  vague  manner  in 
which,  unsubstantiated,  this  statement  is  made,  it  is 
contrary  to  general  opinion,  which  is  worth  something 
when  no  argument  is  brought  against  it. 

In  regard  to  the  production  of  sexes  at  will,  many 
unsupported  theories  are  advanced — one,  that  the  right 
ovary  produces  males,  and  the  left  females,  a  fact 
frequently  disproved,  not  only  by  the  birth  of  twins — 
where  the  placenta  and  membranes  show  whether  one 
or  both  organs  were  concerned  in  the  creation — but 
also  by  the  numerous  failures  of  those  females,  who, 
following  the  propositions  of  the  theory,  assume  a 
position  either  upon  the  right  or  left  side,  immediately 
subsequent  to  commerce. 

Many  curious  investigations  have  been  instigated  in 
regard  to  this  point  in  the  world  of  nature.     It  is  a 


20  PHYSIOLOGY    OF    GENERATION. 

matter  of  familiar  knowledge  that  the  male  and  female 
characteristics  of  the  higher  species  of  the  animal 
creation  are  not  produced  in  the  same  individual  as 
they  are  in  the  great  majority  of  the  higher  species  of 
plants.  The  organs,  as  will  be  seen,  from  which  the 
two  are  evolved,  are,  however,  so  nearly  related  to 
each  other  in  intimate  tiature,  that  the  one  may  be 
readily  mistaken  for  the  other  in  the  earliest  period  of 
their  formation.  Physiologists  now  incline  to  the 
opinion  that  the  fertilizing  vesicle  is  merely  a 
germ  vesicle,  in  a  somewhat  more  exalted  stage  of 
development.  Mr.  Knight  has  shown  that  plants,  like 
the  oak,  that  bear  the  male  and  female  flowers  on 
separate  individuals,  may  be  made  to  produce  either  at 
will,  by  regulating  the  supply  of  light  and  heat 
according  to  the  end  in  view.  If  the  heat  be  excessive 
as  compared  with  the  light,  male  flowers  only  appear ; 
but  if  the  light  be  in  excess,  female  flowers  are 
produced.  He  also  found  that,  whenever  the  eggs 
of  birds  are  not  allowed  to  be  fertilized  until 
immediately  before  they  are  laid,  and  therefore,  their 
own  intrinsic  development  has  been  carried  to  the 
highest  possible  pitch  before  renewed  vivification  of  the 
germ  vesicle  is  effected,  as  many  as  six  out  of  every 
seven  of  the  birds  subsequently  hatched  proved  to  be 
males.  This  view  would  seem  to  corroborate  the 
opinion  entertained  by  Dr.  Hibbard. 

Quetelet  believes  that  the  relative  ages  of  the  male 


DESCRIPTION    OF    THE    OVUM.  ^1 

and  female  parent,  influence  the  sex  of  the  offspring 
produced,  to  a  very  considerable  extent.  In  support 
of  this  theory  M.  Hofacker  has  shown  that  when  the 
father  is  considerably  younger  than  the  mother,  the 
proportion  of  female  to  male  children  is  generally  as 
ten  to  nine  ;  but  that  when,  on  the  contrary,  the  father 
is  nine  years  older  than  the  mother,  the  proportion  of 
male  offspring  to  female  is  as  five  to  four,  and  when 
eighteen  years  older,  as  two  to  one. 

In  a  general  way,  more  males  of  the  human  species 
are  born  into  the  world  than  females.  If  all  Europe 
be  included  in  the  estimate,  the  proportion  of  male 
to  female  births  is  about  106  to  100.  Possibly,  if 
Quetelet's  views  be  based  on  truth,  this  preponderance 
on  the  side  of  the  males  may  be  due  to  the  fact  that  in 
civilized  communities  men,  from  prudential  and  other 
motives,  mostly  marry  women  younger  than  themselves. 
But  there  are  other  reasons  why  this  preponderance 
exists.  Three  male  children  are  born  dead  to  every 
two  female. 

But  before  proceeding  further  we  will  describe 
the  ovum  and  the  male  virile  life-giving  principle 
according  to  the  opinions  of  the  day,  as  proved  by  the 
investigations  of  Bischoff,  Coste,  Donn6,  and  other 
distinguished  physiologists  and  microscopical  observers. 
And  first,  to  render  this  clear,  a  brief  recapitulation 
of  the  leading  anatomical  characteristics  of  the  genera- 
tive organs  will  be  expedient. 


22  PHYSIOLOGY   OF   GENERATION. 


Fig.  1. 


A  is  the  body  of  womb,  B  the  cervix  uteri,  CC  the  vagina,  D  one  of  the  ovaries, 
E£  the  fimbriated  extremities,  F  the  fallopian  tube,  6  the  small  ligament  attaching 
the  fimbriated  extremity  to  the  ovary. 

The  uterus,  or  womb,  is  a  pear-shaped  organ,  in  its 
unfecundated,  healthy  state,  about  two  inches  long  and 
one  wide.  Its  normal  position  will  be  seen  by  reference 
to  Plate  II.  It  has  long  been  divided  into  two  portions 
in  common  parlance,  but  not  until  quite  recently  have 
these  two  parts  been  recognized  by  the  anatomist  and 
physiologist  as  two  distinct  divisions  of  the  same  organ 
in  its  anatomical  character,  in  the  distribution  of  its 
nerves,  and  in  its  functions.  The  knowledge  of  these 
two  distinct  characters  is  most  important  to  the 
accoucheur  and  still  more  to  any  one  engaged  in  the 
treatment  of  all  uterine  diseases,  and  especially  of 
sterility.  The  consideration  of  the  peculiar  functions 
of  these  will  form  a  part  of  the  practical  portion  of  this 
treatise  ;  all  that  is  to  be  here  noted  is  the  duplex 
character  of  the  womb. 


ANATOMY  OF   THE   UTERUS. 


23 


Pig.  2. 


The  uterus  divided  longitudinally,  showing  its  interior  cavity.  A  is  the  os 
internum  uteri,  B  the  os  externum  uteri,  CO  the  horns  from  whence  spring  the 
Fallopian  tubes,  A  to  B  the  canal  of  the  cervix. 


Through  the  centre  of  this  oblong  organ  runs  a 
cavity.  In  the  body  of  the  organ  this  cavity  is  of  a 
triangular  shape  with  the  base  resting  upon  the  fundus 
of  the  uterus,  while  from  each  corner  the  canal  is 
continued.  Those  at  the  base  are  the  Fallopian  tubesj 
which  end  in  the  "fimbriated  extremities,"  and  are 
usually  floating  loose  in  the  cavity  of  the  peritoneum. 
The  opening  at  the  lower  corner  of  the  triangle  is  the 


24 


PHYSIOLOGY   OF   GENERATION. 


canal  of  the  cervix,  and  when  of  natural  size  and 
without  disease,  will  not  allow  an  ordinary  Simpson's 
uterine  sound  to  pass  through  it  without  pain  and  a 
very  decided  pressure,  generally  followed  by  a  bloody 
flow. 

The  shape  of  this  canal  is  generally  misunderstood. 
By  most  it  is  supposed  to  be  of  the  same  size 
throughout.  Bennet  first  noticed  the  incorrectness  of 
this  opinion,  and  half  rectified  the  error,  by  stating  that 
the  interior  orifice,  i.  e.,  where  it  enters  the  body  of  the 
uterus  (A,  Figure  2),  was  manifestly  smaller  than  the 


Fig.  8. 


Fio,  4. 


Kg.  3  represents  the  cavity  of  the  uterus,  according  to  Quain  and  the  older 
anatomists,  the  cs  internum  not  being  recognized,  and  contrasting  markedly  with 
Jigs.  2  and  4. 


FUNCTIONAL    ANATOMY   OP   THE   UTERUS.  26 

general  calibre  of  the  canal.*  So  far  he  was  correct. 
It  is  eqiially  true  that  the  external  orifice  is,  in  virgins, 
when  no  disease  has  existed,  also  smaller  than  the  cavity 
within,  with  difficulty  admitting  a  small  probe. 

The  anatomy  of  the  canal  of  the  cervix,  therefore, 
evinces  that  this  passage  is  short,  of  about  one  and  a 
half  inches  in  length,  of  an  equal  size  throughout, 
except  at  the  external  and  internal  orifices,  and  in  its 
healthy,  virgin  state,  and  when  not  menstruating,  no 
instrument  of  any  size  can  be  passed  into  the  cavity  of 
the  uterus  without  injury  to  the  living  membrane.  A 
large  instrument  cannot  be  passed  without  force,  and  a 
small  one  will  seriously  lacerate  and  puncture  the 
mucous  membrane. 

I  will  here  mention,  what  may  perhaps  be  again 
alluded  to,  that  both  of  these  organs— dividing  the 
body  and  cervix  into  two  organs — are  muscular,  and 
both  susceptible  of  being  irritated  and  provoked  to 
muscular  contractions.  This  has  always  been  recog- 
nized of  the  body,  but  not  so  generally  of  the  cervix. 
But  this  may  easily  be  noted  by  those  treating  uterine 
disease.  It  was  markedly  perceptible  in  a  case  on  the 
morning  of  the  day  on  which  I  write  these  words  (May 
30,  '55),  when  attending  a  female  for  sterility,  at  the 

*  The  opening  of  the  os  uteri  is  of  considerable  size,  and  is  named  the  orificium 
uteri  externum ;  the  canal  then  becomes  narrowed,  and  at  the  upper  end  of  the 
cervix  is  contracted  into  a  smaller  opening,  the  orificium  internum. — Anatomises 
Vade  Meeum,  by  Erasmus  Wilson,  fifth  edition,  London,  1851. 


26  PHYSIOLOGY   OF    GENERATION. 

Northern  Dispensary;  I  invited  my  friend,  Dr.  E.  B. 
Warner,  to  witness  the  operation.  I  passed  a  loose 
piece  of  nitrate  of  silver,  about  three  quarters  of  an 
inch  in  length,  into  the  cavity  of  the  cervix,  by  means 
of  a  long  pair  of  forceps,  and  as  fast  as  it  was  intro- 
duced and  there  left,  it  was  immediately  pushed  out  by 
the  contractions  of  the  neck  of  the  uterus,  and  with  so 
much  force  as  to  be  thrown  out  of  the  vagina.  This 
demonstration  of  the  foregoing  statement  was  most 
satisfactory. 

Fio.  6. 


Fig.  5  represents  the  cervix  uteri,  divided  longitu- 
dinally, and  folded  back  upon  itself,  displaying  the 
peculiar  structure  of  its  internal  living  mucous  mem- 
brane, which,  from  the  arrangement  of  its  folds,  is 
denominated  the  arbor  vitse.  This  formation,  materially 
modifying  and  affecting  the  treatment  of  difficulties  in 
this  situation,  will  be  more  fully  enlarged  upon  in  suc- 
ceeding chapters  of  this  work. 

Attached,  on  each -side  of  the  uterus,  on  a  level  with 


RESULT    OF    BISCHOFF's    POST-MORTEMS.  27 

the  fundus,  are  the  ovaries,  the  internal  testicles,  as 
they  were  formerly  considered,  and  are  now  popu- 
larly called. 

From  the  upper  portion  of  the  uterus,  connecting 
with  the  upper  corners  of  the  interior,  the  angular 
cavity  before  alluded  to,  spring  the  fallopian  tubes, 
terminated  by  their  fimbriated  extremities,  which  are 
sometimes  attached  to  the  ovary  by  a  slight  ligament. 


THE  FUNCTIONS  OF  THE  FEMALE  ORGANS  OF  GENERATION. 

"From  the  commencement  of  puberty  up  to  the 
period  of  involution,  the  ovaries  are  the  seat  of  a 
continual  detachment  of  the  ova  by  dehiscence  of  the 
Graaffian  vesicles,  which,  independently  of  sexual  con- 
gress, takes  place  in  women  and  virgins,  above  all  at 
the  menstrual  period,  although  it  may  and  does  fre- 
quently occur  at  other  times,  under  conditions  not  yet 
accurately  determined." 

The  recent  examinations  by  Prof.  Bischoff,  of  the 
organs  of  generation  of  thirteen  women  who  had  died 
suddenly  by  violence  while  menstruating,  throw  some 
light  upon  the  subject. 

Prof.  B.  remarks  that  these  cases  confirm  the  doctrine 
that,  in  women,  at  every  menstruation,  a  follicle 
ripens,  swells,  and  bursts,  that  the  ovum  escapes,  and 
that  a  corpus  luteum  is  formed.     The  eleventh  case 


28  PHYSIOLOGY    OF    (GENERATION. 

seems  to  prove  that  the  full  consequences  of  menstrua- 
tion are  not,  in  every  instance,  fully  carried  out,  but 
that  a  follicle  may  swell,  and  the  ovum  ripen,  without 
the  bursting  of  the  follicle,  or  the  escape  of  the  ovum. 
Such  a  condition  will  cause  sterility,  notwithstanding 
menstruation.  Perhaps,  also,  the  pain  of  the  menstrual 
period  depends  upon  the  incomplete  development. 

A  woman  may  not  menstruate,  and  yet  she  may 
conceive  ;  for  the  essential  condition,  the  ripening  and 
escape  of  an  ovum,  may  proceed,  and  only  the  usual 
outward  symptoms  of  this  event,  the  secretion  of  blood, 
faiil—Henle's  ^  Pfeufer's  Zeitsckrift,  1853. 

Atj^e  appropriate  season  the  shad  discharges  her 
eggs  upon  the  waters,  trusting  that  they  may  be  found 
^  and  fecundated  by  the  male  ;  the  domestic  hen,  at 
■  proper  intervals,  prepares  a  batch  of  eggs,  which,  when 
sufficiently  matured,  she  "  lays,"  whether  they  are  or 
not  fecundated  by  the  cock.  In  like  manner,  the 
ovaries  of  the  human  female,  at  her  regular  periods  of 
four  weeks,  take  on  action  and  discharge  one  or  more 
eggs,  if  a  virgin  not  to  be  fecundated,  if  in  the  habit  of 
sexual  intercourse,  to  be  or  not  fecundated,  as  other 
circumstances  may  affect. 

The  process  of  menstruation  is  the  laying  of  a  human 
egg,  differing  little  in  its  general  characteristics  on  its 
first  appearance,  from  the  egg  of  a  cow,  a  dog,  or  a 
bird. 

The  menstrual  discharge  is  a  mixture  of  blood  and 


THE    HUMAN    EGG.  29 

glandular  albuminous  secretion.  The  act  of  menstrua- 
tion is  one  in  which  the  whole  genital  apparatus  sympa- 
thizes, if  not  the  entire  constitution.  The  ovisacs,  i.  e., 
the  sacs  containing  the  ova,  usually  called  the  Graafian 
vesicles,  are  contained  within  the  substance  of  the 
ovary.  These  enlarge  during  the  month,  and  in  their 
growth,  approach  the  exterior  of  the  ovary,  till  having 
arrived  at  the  period  of  maturity,  the  sac  bursts,  and 
borne  on  by  a  flow  of  blood  accompanying  this  break- 
ing, the  ovum  is  floated  down  the  canal  of  the  Fallopian 
tube,  the  fimbriated  extremity  of  which,  concealing  the 
open  mouth  of  the  canal,  has,  warned  by  the  general  ute- 
rine disturbance,  been  closely  applied  to  the  ovary,  ready 
for  the  coming  ovum.  The  egg  is  speedily  wafted  through 
this  canal  into  the  cavity  of  the  uterus,  which  transit  it 
accomplishes,  according  to  Pouchet,  in  from  two  to  six 
days.  This  organ  also,  forewarned  of  the  coming  of  the 
ovum,  is  in  a  high  state  of  turgescence,  and  the  numer- 
ous follicular  glands  which  stud  its  inner  surface,  and 
are  continued  through  its  neck,  throw  out  an  abundant 
supply  of  mucus,  glandular,  semi-albuminous  discharge, 
and  sometimes  blood  exudes  from  the  turgid  vessels 
lining  its  surface.  When  this  exhalation  is  limited  and 
natural  in  its  character  and  quantity,  it  forms  a  mem- 
brane, lining  the  interior  of  the  cavity  of  the  uterus, 
which  is  called  the  decidua,  and  in  certain  cases  of 
Dysmenorrhoea,  or  painful  menstruation,  a  similar 
membrane,  or  oftener  membranous  threads  and  strings, 


30 


PHYSIOLOGY    OF    GENERATION. 


are  discharged,  which  are  considered  to  be  semi-organ- 
ized fibrinous  secretions,  from  the  internal  surface  of 
the  uterus. 

If  from  any  diseased  action  or  extraordinary  conges- 
tion of  the  parts,  the  flow  of  blood  and  glandular 
secretion  is  unusually  profuse,  then  the  ovum  may  be 
washed  away,  and  with  the  menstrual  discharge,  be 
borne  out  and  destroyed.  But  if  the  discharge  be  of 
moderate  quantity  then  in  the  cavity  of  the  uterus,  this 
ovum,  caught  in  some  fold  or  cell,  may  remain  until 
its  vitality  is  lost,  and  like  all  effete  matter  of  the 
system,  it  is  voided. 

Fio.  6. 


This  physiological  action  is  easily  traced  in  the  ovary 
of  birds.     In  Figure  6  we  have  a  representation  of  the 


COMPARATIVE    PHYSIOLOGY. 


31 


ovary  of  a  fowl,  a  a  a  are  nearly  mature  ova  contained 
within  their  bags  of  investing  membrane ;  c  c  are 
young  ova  in  their  earlier  stages  of  development ;  at 
b  h  b  ruptured  bags  are  seen,  from  which  mature  ova 
have  escaped.  In  Fig.  7,  the  position  of  the  several 
parts  of  a  matured  ovum  are  represented  in  outline  ; 
p  0  is  the  thickness  of  the  ovarian  bag  ;  o  v  and  r  m  are 


Fio.  1. 


the  proper  investing  membranes  of  the  ovum,  and  c  is 
the  small  germ  vesicle  lying  on  one  side  of  the  large 
yolk  mass,  to  which  reference  will  hereafter  be  made. 

The  ovi^m  quietly  remains  within  the  uterus,  await- 
ing the  fecundating  principle  of  the  male.  In  some 
insects,  with  the  providence  which  lays  up  for  a  day  of 
need,  the  spermatic  fluid  received  at  some  anterior 
period,  is  retained  in  a  place  set  apart  for  this  purpose, 
until  the  ovum  be  formed.  In  a  certain  degree,  this 
may  also  be  the  case  with  the  human  female.      The 


32  PHYSIOLOGY    OF    GENERATION. 

vivifying  principle  may  lie  awaiting  the  coming  ovum, 
for  a  day  or  two  anterior  to  the  period  of  menstruation, 
and  this  opinion  is  sometimes  apparently  made  proba- 
ble by  delivery  occurring  at  a  period  corresponding  to 
the  commencement,  rather  than  the  cessation  of  the 
menstrual  discharge.  BischofF  says,  that  in  all  his 
observations  upon  mammalia,  he  knows  of  no  instance 
where  conception  occurred  after  the  egg  had  reached 
the  uterus,  and  that  the  inclusive  time  of  possible 
impregnation  is  that  from  the  discharge  of  the  egg 
from  the  ovary  until  it  reaches  the  uterus,  and  this  is 
considered  by  him  to  be  but  ten  or  twelve  days. 

These  views  are  directly  opposite  to  those  in  vogue 
some  twoscore  years  ago.  The  doctrine  of  those  days 
was,  that  the  ovum  was  discharged  at  the  time  of 
sexual  intercourse,  and  at  that  time  only — that  the 
ovum  was  in  fact  the  result  of  the  female  orgasm,  in 
the  same  manner  as  the  seminal  fluid  was  the  result  of 
the  male  orgasm.  Sir  Everard  Home,  the  great  phy- 
siologist of  past  days,  even,  stated  that  he  saw  the 
human  ovum  four  days  after  union,  of  which  he  con- 
sidered it  the  direct  result. 

The  secretions  of  the  female  genital  organs, 
except  those  of  the  ovarium,  are,  1,  a  whitish  mucus 
in  the  uterus  and  vagina,  which  in  the  former  is 
derived  chiefly  from  the  uterine  glands,  the  distinc- 
tions of  which  are  mentioned  elsewhere ;  2,  a 
transparent   viscous    albuminous    mucus    in   the    cer- 


i'L.Vl'l:      iL 


PHILOSOPHY    OF     GROWTH    AND     REPRODUCTION.       33 

vix  uteri ;  3,  the  clear,  viscid  secretion  of  the  Bar- 
tholinian  glands,  which  is  poured  out  in  large  quantity 
in  copulation  ;  and  upon  excitation,  as  was  noticed  by 
Hugier  and  Scanzoni,  it  even  frequently  escapes  in  jets, 
which  may  be  ascribed  to  the  muscles  of  the  excretory 
ducts  ;  4,  the  secretions  of  the  minute  sebaceous  and 
mucous  follicles  of  the  external  organs. — {Kolliker.) 

In  order  to  more  clearly  demonstrate  this  subject,  I 
will  here  epitomize  the  present  generally  received 
"  cell  theory  "  of  growth  and  reproduction. 

According  to  the  researches  of  the  celebrated  com- 
parative physiologists  and  microscopists  of  the  present  * 
day,  into  the  philosophy  of  growth  and  reproduction, 
it  is  demonstrated,  as  first  pointed  out  by  Schwann, 
that  at  the  bottom  of  all  vitality  is  a  microscopic  atom, 
which  is  alike  found  in  every  living  thing,  from  that  of 
the  highest  to  that  of  the  lowest  organization.  It  is 
found  in  the  sap  and  in  the  leaf,  in  the  blood  and  in  the 
bone.  So  minute  are  they  in  their  most  attenuated 
state,  that  twenty  millions  could  be  located  on  a  five 
cent  piece.  This  omnipotent  pigmy,  this  type  of  Hfe, 
assumes  a  great  variety  of  appearances,  but  in  all 
possessing  the  same  essential  construction,  and  the 
same  general  form.  Its  generic  name  has  been  Celh, 
a  cell,  or  little  chamber — a  place  provided  for  some 
store.  A  more  acceptable  title,  and  one  which  is 
destined  to  supplant  the  former,  is  vesicula,  or  vesicle. 

3 


34  PHYSIOLOGY    OF    GENERATION. 

A  cell  is  a  hollow  space  ;  a  vesicle  is  a  little  bladder, 
and  such  we  find  this  essence  of  life  to  be. 

The  vesicle  of  organized  structure  consists  of  a  filmy 
layer  of  delicate  membrane,  rolled  up  into  the  form  of 
a  bladder  ;  or,  still  more  correctly,  of  a  hollow  ball,  the 
interior  cavity  being  everywhere  closed  from  external 
space.  This  cavity  always,  however,  contains  some 
kind  or  other  of  material  substance.  The  matter 
contained  within  the  vesicle  is  introduced  by  transu- 
dation through  the  apparently  poreless  membrane. 
Dutrochet  was  one  of  the  first  observers  of  this  curious 
process  of  transudation  through  organic  membranes, 
now  known  by  the  term  "  osmose."  This  is  the  simple 
type  of  all  vitalized  creation. 

The  increase  of  these  vesicles  is  seen  in  the  earliest 
states  of  a  simple  plant,  the  liverwort  or  anthoceros. 
The  delicate  film  is  so  transparent  as  to  allow  the 
substances  contained  in  it  to  be  easily  perceived.  This 
substance  is  a  thick  liquid,  in  which  a  great  number  of 
minute  opaque  globules  float  about,  among  which  is  one 
larger  body,  Fig.  8,  a,  which  first  makes  its  appearance 

Fig.  8. 


•J 

4» 


as  a  speck,  which  soon  assumes  more  importance  by 
attracting  to  itself  portions  of  the  surrounding  mole- 


METAMORPHOSIS    OF    VESICLES.  35 

cules,  and  attaching  them  to  its  own  substance  ;  in  short, 
it  grows  until  it  becomes  itself  a  hollow  structure,  like  to 
that  in  which  it  is  held,  save  in  size.  It  is  then  a  vesicle 
within  a  vesicle — a  kernel  to  the  vesicular  nut,  and  on 
this  account  is  called  the  nucleus.  For  a  certain  time, 
both  the  larger  and  smaller  vesicle  increase  together, 
but  at  length  this  process  of  growth  is  arrested,  and 
streams  of  the  finer  granules  begin  to  flow  backwards 
and  forwards  between  the  outer  wall  of  the  vesicle  and 
the  imprisoned  nucleus,  and  a  very  delicate  filmy  lining 
is  soon  perceived  to  be  separating  itself  within  from  the 
wall  of  the  vesicle,  and  to  be  extending  a  fold  inwards 
towards  the  kernel,  in  the  form  of  a  flattened  ring. 
This  delicate  lining  appears  to  be  a  structure  of  great 
importance,  and  is  called  by  Mohl,  the  German  physio- 
logist, the  "  primordeal  utricle,"  or  the  "original  little 
bag."  This  inward  fold  of  this  living  membrane  at  last 
constitutes  itself  a  complete  partition  across  the  vesicle, 
cutting  the  kernel  also  in  half.  Fresh  cell  film  is  then 
produced  by  it  within  its  own  fold,  and  the  first  vesicle 
is  thus  metamorphosed  into  two.  These  then  both 
grow  in  their  turn,  form  new  nuclei  in  their  interiors, 
develop  partitions,  and  again  divide,  and  thus  in  a 
similar  manner  ad  infinitum. 

In  Fig.  9  the  condition  of  the  cell  drawn  in  Fig. 
8,  is  shown,  after  four  partitions  have  been  developed, 
and  four  distinct  cells  have  been  called  into  being  (one 
of  them  is  on  the  farther  side  of  the  object,  and  invisi- 


36  PHYSIOLOGY    OF    GENERATION. 


Fio.  9. 


ble,  in  consequence  of  lying  beyond  the  focal  reach  of 
the  microscope). 

"Vesicles  which  are  thus  multiplied  by  splitting  into 
pieces,  are  called  Jissiparous  ;  that  is,  producing  by  fis- 
sure or  division. 

Vesicles  are  sometimes  multiplied  by  the  formation 
of  external  buds,  and  are  called  gemmiparous.  The 
delicate  lining  of  the  parent  vesicle,  instead  of  growing 
inward  into  its  cavity  as  a  partition,  is  pushed  out- 
ward, carrying  a  sort  of  pouch  of  the  external  cell- 
wall  before  it ;  and  this  pouch  by  degrees,  gets  nipped 
by  a  narrow  neck  of  communication,  and  at  last  falls 
off  completely,  as  a  distinct  offset  or  bud.  The  parent 
vesicle  is  then  not  resolved  into  two  new  ones,  as  in 
the  cases  described  above,   but  forms   a   young   one. 

Fia.  10. 


This  process  is  seen  in  the  yeast-cell.  Fig.  10,  magni- 
fied many  thousand  times. 


PRIMEVAL    APPEARANCE    OF    MAN.  37 

Both  plants  and  animals,  in  their  most  rudimentary 
forms  of  living  existence,  agree  in  certain  important 
particulars.  They  are  both  isolated  vesicles  of  mem- 
brane, possessing  the  power  of  absorbing  fluid  nourish- 
ment into  their  cavities,  of  growing  to  a  certain  extent 
out  of  the  material  thus  acquired,  and  of  then  forming 
a  brood  of  living  vesicles,  in  all  respects  like  to  them- 
selves. 

Every  animal,  be  it  what  it  may,  the  colossal  ele- 
phant, the  majestic  lion,  the  lord  of  creation  himself, 
all  commence  their  terrestrial  career  as  simple  monads  ; 
they  are  all  unicellular  creatures  before  they  assume 
their  more  dignified  and  complex  conditions.  Man 
begins  life  as  a  small  membranous  vesicle,  full  of  fluid  ; 
c,  in  Fig.  12,  page  40,  is  a  picture  of  his  important 
person  in  the  primeval  stage  of  its  existence  !  In  a  the 
primary  vesicle  is  shown,  contained  within  the  parent 
cell  ;  and  in  which  is  also  a  quantity  of  food  for  the 
early  nourishment  of  the  young  creature  ;  in  J,  the 
protecting  case  is  broken,  and  the  germ  vesicle,  with  its 
environing  nutriment,  has  escaped  from  the  ruptured 
cavity.  This  vesicle  absorbs  through  its  walls  the 
nourishment  that  is  furnished  for  its  use,  and  then 
begins  to  divide  and  subdivide,  as  already  described 
{Page  35),  into  generation  after  generation  of  other 
vesicles,  as  may  be  seen  in  Fig.  11,  a,b,c,  d,  e. 

At  first,  the  multiplying  brood  remains  in  communi- 
cation with  the  body  of  the  parent  animal,  and  all  the 


3^8 


PHYSIOLOGY   OF   GENERATION. 


material  that  is  required  for  the  support  of  the  multi- 
plication is  derived  from  the  parent  blood,  but  subse- 
quently this  connection  is  dissolved,  and  thenceforth 
the  developing  individual  has  to  cater  for  itself.  A 
digestive  apparatus  is  brought  into  play,  and  nourish- 
ment is  prepared  by  it  from  various  sorts  of  food,  from 
the  substance  of  which  the  new  broods  of  vesicles  draw 
their  material.  The  various  subdivided  vesicles  unite  in 
divers  ways,  to  build  up  the  organic  body  of  the  indi- 
vidual. Some  get  encrusted  with  earthy  matter,  and 
are  piled  together  to  form  bones  ;  others  ooze  a  gelatin- 
ous product  through  their  walls,  multiply  therein,  and 
then  set  themselves  fast  as  cartilages  ;  others  coalesce 
into  tubes  ;  others  arrange  themselves  as  the  contractile 


THE    FECUNDATING  PRINCIPLE.  39 

fibres  of  muscular  flesh  ;  others  assume  the  form  of 
nerve-threads  and  nerve-cells,  &c.,  &c.  In  f  of  Fig. 
11,  the  growing  mass  is  represented  as  it  appears  after 
its  moulding  into  a  definite  organic  shape  has  been  com- 
menced ;  and  the  appearance  of  the  new  creature  has 
begun  to  be  assumed — cho,  indicating  the  already  com- 
mencing chorion,  with  its  shaggy  tufts.  These  germ 
vesicles  of  the  animal  frame  are  developed  in  a  mass 
of  condensed  vesicular  structure,  provided  for  their 
structure,  and  termed,  as  before  described,  the  ovary. 
Large,  distinct  vesicles  are  formed  here  and  there  in  this 
mass  ;  and  in  each  of  these  a  true  germ-vesicle  slowly 
makes  its  appearance,  and  gradually  surrounds  itself 
with  nutritious  particles  of  an  albuminous  and  oily 
nature,  attracted  out  of  the  neighboring  blood-vessels  ; 
the  whole  then  gets  covered  by  an  external  membran- 
ous investment,  and  becomes  what  has  already  been 
designated  as  an  ovum  or  egg.  The  outer  protecting 
coat  of  the  ovum  is  called  the  ovisac,  or  egg-bag. 
When  the  ovum  is  quite  mature,  and  the  germ- vesicle 
is  prepared  for  fertilization,  the  wall  of  the  developing 
vesicle  dissolves  entirely,  or  is  ruptured  in  some  part, 
and  the  ovum  escapes  into  a  channel  provided  to  carry 
it  away.  In  Fig.  12,  a  is  the  representation  of  a 
mature  ovum,  containing  a  germ-vesicle  and  nutritious 
particles.  At  h  the  coats  of  the  ovum  are  burst,  and 
the  germ-vesicle  is  seen  falling  from  the  cjcvity.  See  in 
this  connection  b,  b,  b,  in  the  ovary  of  the  fowl,  Fig.  6. 


40 


PHYSIOLOGY    OF   GENERATION. 


The  fecundating  principle,  the  sperm,  the  spermatic 
fluid,  or,  in  scripture  language,  the  seed,  is  a  compo- 
site substance.  The  greater  portion  consists  of  mucus, 
the  secretions  of  the  numerous  glands  which  line  the 
urethra,  the  prostate  gland,  &c.,  and  the  secretion  of 
the  testicles,  which  last  is  the  true  spermatic,  life-giving 
emanation. 

Its  composition,  according  to  the  analysis  of  Yauque- 
lin,  is 


Water, 

Animal  mncilage, 


Phosphate  of  lime, 


900. 
60. 
40. 
80. 


This  true  semen  forms  but  a  small  portion  of  the 
fluid  ejected  from  the  urethra  during  coition,  and  this 
muco-glandular  discharge  ffe  necessary  not  only  to  give 
sufficient  bulk  to  be  effectually  ejaculated  by  the  ducts, 
but  also  is  all-important  to  dilute  the  concentrated  true 


MICROSCOPY    OF    THE    SPERMATIC    FLUID.  41 

semen.  "  The  true  semen,  of  which  we  have  given  the 
chemical  analysis,  as  found  in  the  vas  deferens,  is  a 
whitish,  viscid,  inodorous  material,  consisting  almost 
entirely  of  fertiliziilg  vesicles,  or  spermatic  filaments, 
and  containing  between  these  bodies  an  extremely 
minute  quantity  of  connective  fluid.  ***** 
In  the  pure  semen,  the  filaments  exhibit  no  movements, 
or  scarcely  any,  when  it  is  too  much  concentrated. 
The  movements  are  first  visible  in  the  contents  of  the 
vesiculse  seminales,  'and  in  ejaculated  semen,  or  when 
pure  semen  is  diluted." — (Kolliker.) 

Fig.  13. 


The  fertilizing  vesicles,  spermatic  filaments,  animal- 
cules, Jila-spermatica,  spermatozoa,  Fig.  13,  were  first 
discovered  by  a  German  student,  Louis  Hamon,  August, 
\Q1X,  by  whom  they  were  shown  to  Leeuwenhoeck,  who 
first  made  a  study  of  them.  They  are  perfectly  homoge- 
neous, soft  corpuscules,  in  which  are  distinguished  a 
thicker  portion — the  body  or  head — and  a  filamentary 
appendage — the  filament  or  tail.  The  former  is  flat- 
tened, and  viewed  on  the  side,  pyriform,  with  the  acute 


42  PHYSIOLOGY    OF    GENERATION. 

end  in  front ;  on  the  surface,  oval,  or  even  rounded 
anteriorly,  and  also,  though  more  towards  the  anterior 
part,  slightly  capped. 

The  development  of  the  fertilizing  vesicle  of  the  ani- 
mal is  after  the  same  manner  as  the  germ-vesicle.  Large 
cells  are  especially  set  apart  for  the  purpose,  in  which 
are  gradually  formed  several  nuclei.  These  nuclear 
cells  then  grow  and  mature,  until  they  become  complete 
hollow  vesicles.  Fig.  14  is  a  representation  of  one  of 
the  large  developing  cells  of  the  fertilizing  vesicles  of 
the  sparrow,  with  its  brood  of  young  vesicles  in  the 
interior.     But  when  the  interior  vesicles  have  completed 

Fig.  14 


their  growth,  a  change  begins  to  take  place  in  their 
interior  cavities  also.  An  opaque  granular  matter, 
which  they  contain,  is  moulded  step  by  step  until  it 
has  assumed  a  very  peculiar  form.  A  small,  egg- 
shaped  body,  with  a  long  coiled-up  tail,  is  slowly  shad- 
owed forth  from  the  cavity  of  the  vesicle,  and  grows 
more  and  more  distinct. 

In  Fig.  15,  this  tailed  body  is  seen  at  b,  still  snugly 
lying  in  the  midst  of  the  formative  granules  ;  and  in 


LIFE    OF    THE    SPERMATOZOA.  48 

the  right  hand  sketch,  with  its  structure  perfected,  the 
bed  of  granules  being  all  consumed,  and  nothing  being 

Fio.  15. 


left  around  it  but  the  transparent  walls  of  the  prison. 
At  a  the  tail  projects  through  the  walls,  which  seems  to 
be  a  preparatory  step  to  the  complete  emancipation  of 
the  prisoner.  These  figures  are  taken  from  the  devel- 
oping cell  of  a  quadruped.  This  peculiar  little  body, 
with  the  egg-shaped  body  and  curling  tail,  will  be 
recognized  as  the  "  spermatic  filament,"  as  shown  in 
Fig.  13.  According  to  Dr.  Burnett,  our  distinguished 
countryman,  lately  deceased,  the  spermatic  filaments 
are  not  formed,  as  stated  by  KoUiker,  by  a  deposit 
from  the  contents  of  the  sperm-cell  or  nucleus,  but  by 
an  elongation  of  the  cell  or  nucleus  itself.  It  will  be 
observed  that  its  development  is  an  affair  of  three  gen- 
erations successively.  First,  the  developing  cell  is 
made  in  the  midst  of  a  eellular  mass.  Then  this  cell 
perfects  its  brood  of  secondary  vesicles  {Fig.  14)  and 
next,  each  of  these  vesicles  produces  {Fig.  13)  the 
final  object  of  the  process — the  true  fertilizing  agent, 
the  spermatic  filament,  or  fertilizing  vesicles. 


44  PHYSIOLOGY   OF    GENERATION. 

The  movement  of  these  bodies  is  effected  solely  by 
the  alternate  flexure  and  extension,  or  serpentine 
motion  of  the  filamentary  portion,  or  tail,  in  which 
way  are  produced  such  lively  and  various  undulating, 
rotatory,  quivering  changes  of  place — during  which  the 
head  or  body  always  precedes — that  these  elements  of 
the  semen  were  formerly  regarded  as  animals. 

The  duration  of  these  movements  (i.  e.,  the  life  of  the 
spermatozoa,  or  fertilizing  vesicle),  depends  upon 
various  circumstances.  In  the  dead  body  they  are  not 
unfrequently  perceptible,  even  twelve  to  twenty-four 
hours  after  death  (on  one  occasion  Valentin  noticed 
faint  motion  at  the  end  of  eighty-four  hours),  and  in  the 
female  genital  organs  of  the  mammalia,  they  exhibit 
motion  even  after  seven  or  eight  days  {Leeuwenhoeck, 
Prevost  and  Dumas).  Water  at  first  renders  the 
motions  more  lively,  but  they  soon  cease,  and  the 
filaments  are  not  unfrequently  curved  in  a  loop-like 
form.  Blood,  milk,  mucus,  pus,  syrup,  and  a  dilute 
saline  solution,  have  usually  no  injurious  effect ;  but  it 
is  otherwise  with  urine  ( Wagner)  and  bile,  the  former 
¥  particularly,  when  it  is  strongly  acid  or  much  diluted. 
All  chemical  reagents,  acids,  metallic  salts,  caustic  alka- 
Hes,  &c.,  cause  the  motion  to  cease,  as  do  narcotics, 
when  they  act  chemically  upon  the  filaments,  or  are  too 
much  diluted ;  especially  uterine  mucus,  of  a  decided 
alkaline  character,  is  destructive  to  their  vitality. 
(Don7i4). 


MANNER    OF    IMPREGNATION.  45 

The  formation  of  the  spermatic  filaments  and  of  the 
semen,  it  is  true,  usually  ceases  in  old  age,  although 
they  are  not  unfrequently  found  in  men  of  sixty, 
seventy,  or  even  eighty  years  of  age,  and  even  accom- 
panied— though  this,  it  must  be  confessed,  is  an  unusual 
phenomenon — with  the  procreative  faculty. 

"  That  the  seminal  filaments  are  not  animalcules,  but 
elementary  parts  of  the  male  organism,  it  is  useless,  at 
the  present  time,  to  demonstrate  (Leeuwenhoeck  and 
Spallanzani,  insist  that  they  are  animalcules.  Ehren- 
burg  considers  them  among  the  microzooaires  suceurs, 
while  Czermak,  placing  them  among  the  infusoria, 
classes  them  among  the  vibriones  and  the  cercaires. 
Indeed,  the  former  saw  stomachs  and  intestines  in 
them,  and  Schwann  and  Henle  made  the  important  dis- 
covery that  they  had  mouths)  although  it  is  still  as 
much  as  ever  unknown,  and  may  not  easily  be  soon 
ascertained  what  is  effected  by  their  curious  move- 
ments, which  are  obviously  intended  to  convey  them  to 
the  ovum  from  the  uterus,  which  they  probably  reach 
in  fruitful  congress.  Nor,  from  the  experiments  of 
Prevost,  Dumas,  Schwann  and  Leuckart,  can  the  least 
doubt  be  entertained  that  they  are  the  true  impregna- 
ting agent,  and  for  the  purpose  of  impregnation  must 
necessarily  come  in  contact  with  the  ovum.  The  cir- 
cumstance that  motile  spermatic  filaments  alone  possess 
the  fertilizing  property,  and  according  to  Newport 
{Neivpnrt  Phil.  Trans.,  1851,  I),  that  the  effect  upon 


46  PHYSIOLOGY    OF   GENERATION. 

the  ovum  takes  place  immediately  upon  the  contact, 
although  a  short  duration  of  the  contact  of  the  sper- 
matic filament  with  the  ovum  is  necessary  to  render  it 
efficient,  also  shows,  as  it  appears  to  me,  that  they  do 
not  act  by  aflfording  any  material  substance  to  the  egg, 
but  in  consequence  of  their  exciting  actions  in  it,  as 
bodies  in  a  state  of  peculiar  activity." — {Kolliker). 

According  to  Mr.  Newport's  researches,  impregnation 
is  effected  by  the  spermatic  cilia  alone,  and  not  by  the 
agency  of  the  liquor  seminis.  It  was  found  that  when 
the  seminal  fluid  was  filtered,  so  as  to  separate  the 
spermatozoa  almost  entirely  from  the  liquor  seminis, 
the  impregnating  power  of  the  spermatozoa  was 
immense,  while  that  of  the  liquor  seminis  was  very 
small,  and  commensurate  only  with  the  small  number 
of  spermatozoa  which  had  passed  through  the  filter. 
When  the  spermatozoa  were  entirely  separated,  the 
liquor  seminis  was  found  quite  incapable  of  impregnat- 
ing ova. 

According,  therefore,  to  this  statement,  the  most 
modern  received  opinion,  the  vivifying  principle  is  a 
spermatic  filament  or  vesicle,  which  must  come  into 
contact  with  the  ovum  of  the  female,  when,  by  some 
as  yet  undiscerned  manner,  a  new  life  is  the  result, 
possessing  marked  properties  and  characteristics,  often 
indicating  the  persons  from  whence  each  portion  come. 


VITALITY   OF    THE   SPERMATOZOA.  47 


IN   WHAT  MANNER   DO    THESE   ELEMENTS   UNITE  ? 

In  the  act  of  copulation  the  virile  organ,  in  ordinary 
cases,  penetrates  into  the  vagina  to  the  distance  of  from 
three  to  four  inches,  and  upwards,  or  to  such  a  distance 
that  the  corona  glandis^  or  the  extremity  of  the  organ, 
is  in  immediate  approximation  with  the  opening  of  the 
uterine  canal,  the  os  uteri.  Here  the  spermatic  fluid  is 
discharged 

According  to  most  physiologists,  the  active  labors  of 
the  spermatozoa  here  commence,  which  accordingly,  as 
if  imbued  with  a  knowledge  of  its  duties,  or  pressed 
forward  by  instinct,  commences  to  make  its  way 
through  the  patulous  mouth  of  the  uterus,  into  its 
cavity,  and  not  finding  the  ovum  there,  prolonging  its 
search  through  the  length  of  the  Fallopian  tubes,  even 
to  the  ovary  itself  Some  microscopists  have  recently 
asserted,  that  they  had  seen  the  ovum  just  emerging 
from  the  ovary,  already  surrounded  by  the  spermatozoa 
rapidly  moving  around  it,  and  embracing  it ;  others, 
that  they  had  noted  the  ovum  transfixed  by  the  sperma- 
tozoa, the  head  being  imperceptible,  and  the  tail  alone 
noticeable,  quivering  with  evident  vitality. 

A  popular  opinion,  but  which  has  attained  currency 
without  foundation  upon  which  to  base  it,  that  I  am 
aware  of,  declares  that  in  the  act  of  copulation,  at  the 


48  PHYSIOLOGY    OF    GENERATION. 

time  of  the  "  crisis,"  or  height  of  venereal  sensation  on 
the  part  of  the  female,  the  mouth  of  the  womb  opens  to 
receive  the  Danaean  shower,  and  the  spermatic  fluid  is 
ejected  immediately  into  the  cavity  of  the  uterus. 

So  Uttle  is  known  of  the  os  and  cervix  uteri  in 
its  minute  anatomy,  and  its  physiological  action  and 
sympathies,  either  in  a  healthy  or  a  diseased  state,  that 
there  may  be  some  truth  in  this  opinion. 

Kolliker  states  :  "  It  is  probable  that  movements 
take  place  at  the  time  of  menstruation,  and  in  the  act 
of  congress,  but  the  fact  has  not  been  ascertained.  In 
the  latter  case,  an  opening  of  the  os  uteri,  and  a  dilata- 
tion of  the  canal  of  the  cervix  are  commonly  supposed 
to  take  place.  If  this  is  to  be  regarded  as  a  spon- 
taneous action  of  the  cervix,  it  would  be  justifiable, 
with  Kiwisch,  to  refuse  assent  to  the  supposition,  for 
the  radiating  fibres  described  by  Kaspar,  which  alone 
could  efiect  anything  of  the  kind,  do  not  exist ;  the 
fact,  nevertheless  is  conceivable,  if  we  assume  a  relax- 
ation of  the  muscular  element  in  the  cervix  and  os, 
together  with  a  contraction,  especially  of  the  longitud: 
inal  fibres,  in  the  fundus  and  body." 

It  is  further  added,  that  in  order  to  fecundation,  it  is 
very  important  that  the  female  should  participate  in 
the  excitement  and  pleasure  of  the  act,  for  without 
such  participation  the  os  uteri  remains  closed,  and  the 
female  childless. 

To  this  impassionless  performance  of  the  act  from 


WHY    WOMEN    ARE    CHILDLESS.  49 

personal  repulsion  to  the  male,  is  ascribed  the  fact, 
that  women  raped,  and  virgins  forcibly  deflowered,  are 
rarely  impregnated  —  why  women  are  childless  with 
their  first  husband,  and  fruitful  with  a  succeeding  one. 

The  fact  that  many  women  are  passionless,  and  yet 
have  sometimes  very  large  families,  or  that  women 
brutally  forced  are  occasionally  impregnated,  seems 
to  controvert  the  general  theory  upon  this  subject. 
(I  am  personally  acquainted  with  a  physician  and  his 
wife,  who  have  a  large  family,  increasing  rapidly  by  the 
addition  of  one  a  year,  where  the  female  never  has 
experienced  any  sensual  gratification,  as  the  husband 
states.)  I  shall  have  occasion  to  refer  to  this  view 
when  treating  upon  the  cure  of  barrenness. 

Some  have  argued  that  the  spermatozoa  possessed  an 
instinct  which  compelled  it  to  seek  for  the  ovum,  from 
the  fact  that  it  was  not  necessary  for  the  seminal  fluid 
to  be  thrown  into  contact  with  the  os  uteri.  The  virile 
member  is  occasionally  so  diminutive  as  not  to  extend 
more  than  an  inch  and  even  less  into  the  vagina  ;  from 
the  effect  of  stricture,  the  power  of  ejection  is  greatly 
diminished,  so  that  the  semen  is  not  thrown  far  into 
the  canal ;  that  from  congenital  malformation,  hypos- 
padias, or  the  consequence  of  accident,  the  opening  of 
the  male  urethra,  is  sometimes  upon  the  lower  surface 
of  the  penis,  and  often  so  close  to  the  body  as  scarcely 
to  enter  the  vagina  in  the  act  of  copulation,  and  yet 
fecundation  follows  the  act. 


1 


50  PHYSIOLOGY   OF    GENERATION. 

The  recent  decision  of  microscopists,  already  quoted 
from  Kolliker,  stating  that  the  spermatozoa  is  not  an 
animalcule,  will  set  this  theory  at  rest. 

We  must,  therefore,  account  for  the  arrival  of  the 
•'  spermatic  filament "  in  the  uterus  in  some  other  way — 
by  its  specific  gravity,  the  fluids  of  the  vagina  flowing 
back  towards  the  uterus,  while  the  female  is  in  the 
recumbent  position,  during  and  succeeding  the  act — 
that  this  may  be  worthily  considered  in  this  connection 
is  the  popular  theory,  that  procreation  cannot  be 
effected  in  a  standing  position,  and  that  violent  dancing 
immediately  after  sexual  intercourse,  will  prevent 
pregnancy — by  the  semen  being  carried  far  up  into  the 
vagina  by  the  mechanical  action  during  the  season  of 
intercourse,  a  not  improbable  manner  ;  or  by  some 
other  method  by  which  the  vital  principle  of  the  semen 
is  transmitted  to  the  ovaries, 

This  latter  view  demands  a  particular  attention.  A 
physician.  Dr.  Brundige  of  this  city,  of  decided  anatom- 
ical ability,  states  that  he  has  discovered  two  passages 
leading  from  the  vagina  direct  to  the  ovaries.  This 
demonstration  I  have  never  seen,  but  it  is  thus  verbally 
described  to  me. 

From  near  the  external  orifice  of  the  vagina,  upon 
the  superior  verge  of  the  vulva,  and  upon  either  side, 
there  may  be  often  found  a  follicle  sufiiciently  notice- 
able. It  is  of  small  size,  and  by  inserting  a  probe,  a 
pervious  canal  may  be  traced  running  posteriorly  and 


DIRECT    PASSAGE    TO    THE    OVARIES.  61 

laterally  along  the  broad  ligaments,  until  it  reaches  the 
ovary.  It  is  not  always  to  be  found  in  the  human 
female,  and  sometimes  but  one  only  can  be  discerned, 
communicating  with  but  one  ovary.  He  states  that 
in  other  mammalia,  these  passages  are  found  with  more 
constancy. 

I  am  inclined  to  think,  however,  that  the  discovery 
claimed  by  Dr.  Brundige  was  only  the  re-statement  of 
an  exploded  view,  made  some  time  since  by  a  Swedish 
anatomist,  where  the  supposed  conduit,  never  after- 
ward satisfactorily  demonstrated  to  exist,  is  but  the 
remains  of  the  Wolfian  bodies.  Still  there  is  some 
authority  for  this  statement,  for  M.  Baudelocque  stated 
{Acad.  Roy  ale  de  Med.,  12th  February,  1826)  that  he  had 
discovered  a  canal  which  proceeds  from  the  right  Fallo- 
pian tube,  passes  into  the  parietes  of  the  uterus,  and 
opens  into  the  cavity  of  the  cervix. 

Its  only  occasional  presence  in  the  human  female,  as 
alleged,  would  seem  to  indicate  that  it  was  merely  a 
correspondence  of  nature,  and  not  in  woman,  generally 
of  any  practical  importance.  Still  it  would  seem  that 
perhaps,  in  a  few  cases,  such  a  passage  might  exist, 
through  which  the  vital  principle  of  the  seminal  fluid 
might  pass,  and  through  which  it  did  pass  in  the  few 
cases  of  pregnancy  occurring  where  an  imperforate 
hymen,  or  any  important  malformation,  or  deficiency 
of  the  male  organ  existed. 

By  whatever  route  the  fecundating  principle  takes, 


62  PHYSIOLOGY    OF    GENERATION. 

it  ultimately  arrives  at  the  ovary.  Without  much 
doubt,  it  is  through  the  canal  of  the  cervix,  the  uterus, 
and  the  Fallopian  tubes.  The  only  argument  against 
this  proposition  is  a  theoretical  one.  It  is  stated,  that 
nature,  in  no  other  instance,  has  created  a  canal  or 
passage  which  serves  two  opposite  purposes,  i.e.,  which 
serves  at  the  same  time  both  as  an  outlet  and  an  inlet ; 
that,  therefore,  if  the  Fallopian  tube  allows  the  fecun- 
dated ovum  to  come  down  in  its  passage  to  be  deposited 
in  the  uterus,  the  spermatozoon  must  find  some  other 
way  up.  As  neither  argument,  corroborating,  nor  con- 
tradictory hypothesis  can  settle  this  matter,  and  as  it  is 
not  important  to  my  plan,  I  shall  leave  the  question 
with  the  mere  statement  of  the  two  sides  of  the  subject. 

How  the  fecundation  is  effected  is  still  as  much  a 
matter  of  doubt  as  ever.  The  astronomer  in  vain 
enlarges  his  telescopes,  the  instrument  of  double  power 
but  divides  the  supposed  single  star,  leaving  each  as 
undetermined,  as  the  original — and  the  laborious  embry- 
ologist  in  vain  traces  the  spermatozoon  in  its  path,  and 
even  when  the  microscope  reveals  him  at  his  final 
entrance  into  the  ovum — how  the  new  creation  is 
effected,  is  still  a  mystery  above  the  ken  of  ordinary 
mortals. 

All  that  is  necessary  to  effect  the  renewed  fertiliza- 
tion of  the  germ  vesicle  of  an  animal,  is  the  bringing 
of  a  fertilizing  vesicle  into  contact  with  the  membrane 
of  the  ovum  in  which  it  is  contained.     An  interming- 


UNION    OF    MALE    AND    FEMALE    VESICLES.  63 

ling  of  the  contents  of  the  two  vesicles  then  takes  place, 
osmometric  transudation  occurring  through  the  inter- 
vening membranes.  Most  physiologists  now  believe 
that  the  contents  of  both  vesicles  play  their  own  parts 
in  the  production  of  the  germ  that  is  to  develop  a  new 
creature,  and  that  it  is  on  this  account  the  offspring 
ultimately  presents  some  of  the  characteristics  of  each 
parent.  Wagner  conceives  that  the  germ  vesicle  bursts 
and  mingles  itself  with  the  albuminous  and  oily  matters 
that  surround  it  in  the  ovum,  and  that  the  contents  of 
the  fertilizing  vesicle  then  pass  into  the  ovum  too,  the 
entire  ovum  becoming  the  fertile  germ  vesicle.  Dr. 
Martin  Barry  believes  that  fertilization  never  takes 
place  unless  the  fertilizing  vesicles  pass  bodily  through 
the  membranes  of  the  ovisac,  and  get  amidst  the  oily 
and  albuminous  matter  within,  as  stated  more  fully  in 
the  following  paragraph.  Mr.  Newport  stated  that  this 
was  by  no  means  necessary,  and  that  the  mere  contact 
of  the  fertilizing  vesicle  with  the  outer  covering  of  the 
ovum  for  four  or  five  seconds  is  sufficient  to  ensure  the 
fertilization  of  the  germ  vesicle,  although  a  merely 
instantaneous  contact  is  not  sufficient  for  the  purpose. 

Drs.  Barry  and  Nelson  have  since  re-affirmed,  and 
published  their  observations  of  the  entrance  of  the 
spermatozoon  into  the  ovulum  ;  but  their  statements 
were  not  regarded  as  completely  satisfactory,  but  sup- 
posed to  be  disproved  by  Newport,  till  Keber,  following 
the  path  which  they  had  pointed  out,  and  examining 


54  PHYSIOLOGY    OF    GENERATION. 

the  fresh  water  muscle,  unio,  in  which  this  portion  of 
conception  is  peculiarly  evident,  made  out  and  described 
the  different  stages  of  this  wonderful  function.  Bis- 
choff,  who  at  first  denied  most  strenuously,  now  fully 
corroborates  this  statement. 

"  In  the  fresh  water  muscle  (unio),  at  the  time  of 
conception,  the  ovulum,  although  still  small,  projects  at 
one  part  a  minute  process  which  springs  from  the  mem- 
brane of  the  abdomen,  and  perforates  the  cortical 
membrane.  This  process  dehisces,  lets  escape  a  little 
albumen,  and  admits  one  of  the  spermatozoa  which 
surround  it.  This  done,  the  mycropyle,  as  it  is  called, 
again  closes  by  constriction  or  obliteration. 

"  Afterwards  (and  sometimes  earlier),  there  is  formed 
near  the  mycropyle  an  adhesion  between  the  membranes 
of  the  albumen  and  of  the  yelk,  then  the  yelk-bag 
dehisces,  receives  the  spermatozoon  into  its  interior,  and 
again  is  closed. 

' '  The  spermatozoon  afterwards  sinks  deep  into  the 
yelk,  swells,  and  becomes  rounded ;  after  some  time  a 
nucleus  appears  in  it,  while  its  outer  membrane  thins, 
and  at  length  disappears. 

"  The  nucleus  of  the  spermatozoon  splits  up  into 
several  irregular  divisions,  which  at  first  lie  near  one 
another,  and  then  become  diffused  through  the  yelk,  so 
that  before  the  dissolution  of  the  germinal  vesicle,  the 
yelk  is  filled  with  small  particles  from  the  male." — 
Ed.  Med.  ^  Surg.  Jour. 


PASSAGE    OF    THE    OVUM.  66 

Da  Costa  has  doubted  the  correctness  of  this  assertion 
of  Keber,  but  the  recent  endorsement  by  Bischoff  would 
seem  to  settle  the  matter. 

The  passage  of  the  ovum  after  its  escape  from  the 
ovary,  is  a  matter  of  some  interest.  In  the  fowl  we 
have  seen  it  in  Fig.  6  and  7.  It  falls  from  the  ovary 
into  a  tube  with  a  funnel-shaped  end,  through  which  it 
rolls  along,  with  a  slight  twisting  movement,  enveloping 
itself  in  a  quantity  of  viscid  liquid  albumen,  secreted 
by  the  tube  as  represented  by  the  Fig.  16,  where  we 

Fig.  16. 


see  the  ovum  enclosed  in  albumen  slightly  coagulated, 
to  show  the  spiral  way  in  which  the  mass  is  arranged 
in  consequence  of  the  twisting  of  the  ovum.  At  the 
further  end  of  the  tube,  the  secretion  changes,  and  a 


56  PHYSIOLOGY   OF    GENERATION. 

deposit  of  membrane  and  lime  is  made  over  the  albumen, 
and  we  have  the  shell,  the  membrane,  the  white  of  the 
egg,  the  yelk,  and  the  true  germ  vesicle  floating  within. 
The  ovum  is  kept  in  its  central  place  within  the 
investing  albumen,  by  the  instrumentality  of  a  couple 
of  twisted  ropes  of  albumen,  one  at  either  end — X  X 
in  the  figure. 

The  egg  of  the  fowl  is  many  hundred  times  larger 
than  the  egg  of  any  mammalia,  and  it  is  for  this  reason 
that  the  former  is  soon  separated  from  the  parent,  while 
the  latter  is  longer  cherished  ;  the  germ  vesicle  of  the 
former  is  to  be  nourished  by  the  yelk,  and  its  albumin- 
ous subordinate,  but  that  of  the  latter  is  supplied 
direct  from  the  parental  blood. 

The  human  egg  in  a  similar  manner  falls  from  the 
ovary  into  the  Fallopian  tube,  and  arrives  in  the  cavity 
of  the  uterus.  The  nutritious  matter  surrounding  it, 
is  sufficient  but  for  a  few  days.  We  have  already 
shown  how  the  cells  in  the  yolk  may  divide  and  sub- 
divide, Fig.  11,  and  finally  where  the  ovum  throws 
out  little  rootlets  from  the  chorion  interlacing  with  the 
maternal  portion,  and  from  thence  drawing  its  nutri- 
ment as  in  Fig.  11,  /". 

The  further  tracing  the  growth  of  the  human  egg,  as 
it  is  more  and  more  fully  developed,  is  unimportant  for 
the  purposes  of  this  treatise,  and  I  leave  it  here 
unfinished.  Curious  and  miraculous  indeed  is  its  won- 
drous growth.     Within  three  or  four  weeks  of  the  first 


GROWTH    OF    DEVELOPMENT.  57 

division  of  the  germ  vesicle,  the  foundations  of  the 
eyes,  limbs,  and  the  spinal  cord  are  laid.  In  two 
more  weeks  traces  of  forming  bone  are  observed,  a  face 
is  sketched  out,  and  fingers  may  be  traced.  In  another 
two,  a  forehead,  lungs,  and  ribs  have  been  added.  In 
another  month  a  rudimentary  brain,  and  a  two-sided 
heart.  In  two  months  additional  the  nails  and  teeth 
bud,  and  in  four  beyond  this,  every  organ  in  the 
scheme  that  is  necessary  for  the  accomplishment  of 
human  life.  Then  this  growth  of  development  ceases  ; 
thenceforward  all  growth  is  that  of  augmentation. 


68  PATHOLOGY    OF    STERILITY. 


II. 

PATHOLOGY  OF  STERILITY. 

From  what  has  already  been  said  in  the  previous 
chapter,  after  copulation,  fecundation  is  ensured  upon 
certain  conditions. 

First,  on  the  part  of  the  male — that  the  semen  be 
emitted  in  loco ;  that  it  contain  the  vital  principle  ; 
that  it  be  unmingled  with  syphilitic  taint,  or  other 
morbific  poisons. 

It  will  be  seen  that  this  modern  view  entirely 
discountenances  the  speculations  of  Spallanzani  in 
behalf  of  the  sympathetic  theory. 

These  circumstances  may  not  occur,  as  before  alluded 
to,  first,  from  the  abnormal  size  of  the  male  organ, 
either  from  its  diminutiveness  rendering  it  insufficient, 
or  from  its  excessive  magnitude,  preventing  its  entrance. 
Albinus  has  recorded  a  case  of  divorce  granted  by  the 
Dutch  courts,  propter  magnitudinem  ipsius  penis.  A 
suit  for  divorce  was  commenced  within  a  few  years  in 
this  city,  quashed  by  the  death  of  the  female  before 
trial  came  on,  where  divorce  was  sought  for  upon  this 
ground  ;  the  evidence  being  that  the  virile  member  of 


DEFICIENCIES    OF    THE    MALE.  59 

the  husband  was  eleven  inches  in  length  in  its  unexcite 
condition.  Also,  from  its  unnatural  direction,  or  mal- 
formation of  the  fraenum,  from  stricture  of  the 
urethra,  which  may  retain  the  semen  from  flowing  out ; 
hypospadias,  or  a  fistulous  opening  into  the  urethra  may 
allow  the  semen  to  escape  externally  ;  an  elongated 
prepuce  tightly  closed  over  the  gland  may  act  as  a 
purse  or  bag,  retaining  the  semen  within  its  cavity,  to 
be  discharged  only  after  the  organ  is  withdrawn  from 
the  vagina,  and  the  erect  condition  passing  off,  allows 
it  to  flow  forth  freely. 

Secondly,  the  spermatic  fluid  may  be  devoid  of 
spermatozoa  ;  from  disease  of  the  testis  ;  from  the 
effect  of  poisonous  drugs  ;  from  mercurialization  ; 
from  mere  old  age.  * 

Thirdly,  constitutional  syphilis,  acute  blennorrhagic 
discharge," or  chronic  gleet  may  destroy,  by  its  admix- 
ture, the  vitality  of  the  seminal  emission. 

The  consideration  of  the  deficiencies  of  the  male 
parent  belongs  to  a  treatise.,  on  impotence,  or  the  dis- 
orders of  the  male  genital  apparatus,  and  they  are  here 
but  briefly  alluded  to  en  passant. 

Secondly,  on  the  part  of  the  female,  the  semen  of 

*  Rare  examples  are  on  record  of  virility  in  men  of  very  advanced  age  ;  thus, 
Massinassa,  king  of  Numidia,  begat  Methynate  after  86  years.  Wadilas,  king  of 
Poland,  had  two  children  at  90,  and  Thomas  Parr  possessed  all  his  powers,  as 
is  well  known,  at  100  years.  I  knew  a  child  of  the  Hon.  Jeremiah  Smith  of  New 
Hampshire,  begotten  at  considerably  over  80,  who  possessed  the  form  and 
features  of  the  Judge  in  a  marked  degree. 


60  PATHOLOGY   OF    STERILITY. 

the  male  may  fail  to  enter  into  the  vagina,  or  the 
uterus,  or  its  vital  principle  to  come  in  contact  with 
the  ovum,  which  is  consequently  left  unfecundated  ;  its 
vitality  may  be  destroyed  by  acrid,  vitiated,  syphilitic, 
blennorrhagic,  or  cancerous  discharges  ;  or  it  may, 
without  any  change,  be  washed  away  by  the  immense 
flow  of  the  leucorrhoeal  exhalations. 

The  semen  of  the  male  may  fail  to  enter  into  the 
vagina,  or  the  uterus,  or  its  vital  principle  to  come  into 
contact  with  the  ovum. 

It  may  fail  to  enter  into  the  vagina,  from  malforma- 
tion of  the  vagina  itself.  It  is  proper  to  allude  in  this 
connection  to  the  rare  cases  of  adhesion  of  the  labia 
from  inflammation,*  and  to  the  still  more  uncommon 
cases  where  no  vagina  existed,  as  in  the  case  reported 
by  Fod^r^,  as  occurring  in  1722,  and  again  another,  by 
Amussat,  to  the  French  Institute  in  1835. 

Not  an  uncommon  form  of  this  difficulty  arises  from 
an  unusual  growth  of  the  hymen,  closing  up  entirely  all 


*  The  most  common  cause  of  this  abnormal  condition  is  its  intentional  production 
by  the  surgeon  to  alleviate  worse  evils.  Thus  my  esteemed  friend,  Dr.  H.  Weeks 
Brown  of  this  city,  during  the  last  year,  united  the  labia-majora,  the  only  opera- 
tion possible,  to  relieve  the  dire  effects  of  a  complete  prolapsus  uteri.  This  serious 
and  bold  operation  was  entirely  successful.  Within  a  few  months,  I  assisted  my 
friend,  Dr.  Sims,  in  his  operation — the  operation  of  this  century — for  vesico 
vaginal  fistula.  The  base  of  the  bladder  was  entirely  destroyed,  and  the  only 
possible  operation  was  to  destroy  the  vagina.  This  unique  and  hazardous,  yet 
successful  operation,  was  effected  by  passing  sutures  of  silver  wire,  fastened  by 
clamps,  from  the  rectum  posteriorly,  through  the  labia  majora  anteriorly. 


VARIATIONS    IN    THE    FORM    OP    THE    HYMEN.  61 

entrance  to  the  vagina.  "  This  organ  assumes  a  great 
variety  of  appearances  ;  it  may  be  a  membranous 
fringe,  with  a  round  opening  in  the  centre,  or  a  semi- 
lunar fold,  leaving  an  opening  in  front ;  or  a  transverse 
septum,  leaving  an  opening  both  in  front  and  behind  ; 
or  a  vertical  band,  with  an  opening  at  either  side." 
Tolberg,  in  his  Medical  Jurisprudence,  I  think,  enumer- 
ates thirty  different  varieties. 

When  this  organ  is  imperforate,  the  menstrual  fluids 
are  not  apparent,  and  are,  when  secreted,  retained  within 
the  vagina,  and  the  uterine  cavity — the  uterus  gradu- 
ally expanding  to  receive  the  monthly  accession — until 
the  protuberance  of  the  abdomen  and  other  symptoms 
plainly  evince  the  retained  fluids. 

The  quantity  thus  retained  is  sometimes  immense. 
In  a  case  operated  upon  at  the  London  Hospital  it 
amounted  to  two  gallons.  Oases  of  death  are  on  record 
from  the  filling  up  of  the  Fallopian  tubes  after  the 
uterus  is  overflowed,  and  its  escape  into  the  cavity 
through  the  fimbriated  extr^jnity,  produces  peritonitis. 

More  frequently  the  orifice  is  small,  and  sufficient  to 
allow,  sometimes  with  accompanying  pain,  the  discharge 
of  the  menses. 

In  rare  instances,  the  hymen,  which  is  usually  a  thin 
and  easily  dilated,  or  lacerated  membrane,  proving  but 
a  feeble  barrier  to  sexual  congress,  is  made  of  sterner 
stuff,  and  resists  all  the  force  which  can  be  brought 
against  it  by  the  male  organ,  or  the  finger  of  the 
examiner. 


62  PATHOLOGY    OF    STERILITY. 

A  lady  who  recently  came  under  my  notice,  had  been 
married  some  ten  years,  and  with  whom,  for  this  reason 
only,  sexual  intercourse  had  never  been  consummated, 
false  modesty  being  overcome,  she  applied  to  her  phy- 
sician, who  consulted  me  in  respect  to  the  case,  when, 
after  appropriate  means  were  used,  congress  was  not 
only  facile,  but  I  believe  fruitful  in  its  results. 

Another  form  of  mechanical  impediment  arises  from 
the  contractions  of  the  vagina.  These  may  be  the 
effect  of  disease,  or  the  cicatrices  of  wounds.  I  might 
say  that  it  was  possibly  sometimes  congenital,  but 
that  I  think  it  scarcely  probable,  and  rather  that  this 
condition  is  the  result  of  inflammation,  which  at  an 
early  age  not  unfrequently  occurs  in  poor  and  ill-cared 
for,  neglected  children  of  every  class. 

Dirt,  primary  and  inherited  constitutional  syphilis, 
not  only  frequently  are  followed  by  adhesive  inflamma- 
tion and  contraction  of  the  vagina,  but  gonorrhoea, 
leucorrhcea,'and  others  of  the  profluvia,  by  their  acrid 
nature,  inflame  and  irritate  these  textures,  and  the 
resulting  scar  of  the  acute  inflammatory  affection  is  the 
cicatrized  or  contracted  vagina. 

External  wounds  from  injuries,  falls  upon  sharp 
stones,  fences,  tools,  or  other  objects,  have,  during  the 
recuperative  process,  resulting  in  the  cure  of  the  wound, 
so  contracted  the  vagina  as  to  entirely  preclude  the 
entrance  of  the  male  organ. 

Instances  of  which  I  have  known,  have  arisen  from  a 
fall  upon  any  sharp  instrument.     Several  are  recorded 


INJURY   FROM   IMPALEMENT. 


63 


in  various  medical  journals,  where  the  patient  was 
impaled  by  falling  upon  the  upright  handle  of  a 
pitchfork,  &c.  {Am.  Jour,  of  Med.  Sciences),  Oct.  1853, 
pp.  365-399. 


Fio.  17. 


In  Fig,  17,  we  have  a  representation  from  Prof.  Meigs, 
of  an  unusual  form  of  stricture  of  the  vagina,  which 


64  PATHOLOGY    OF    STERILITY. 

was  the  cause  of  an  almost  fatal  error  in  diagnosis. 
Similar  strictures  are  occasionally  seen,  which  it  is 
necessary  to  remember  and  to  recognize.  In  the  case 
above  displayed,  the  stricture  in  the  vagina  a,  was 
supposed  to  be  the  open  os  uteri,  which,  as  may  be 
noted,  b,  is  an  inch  or  two  higher. 

Wounds  during  previous  tardy  labors  have  often 
resulted  in  sloughing,  general  disorganization,  contrac- 
tions, and  cicatrizations.  Dr.  Joel  Foster  consulted  me 
in  the  case  of  a  lady  where  such  a  result  occurred,  the 
inflammation  being  so  extensive  and  so  intense  as  to  be 
followed  by  entire  union  of  the  sides  of  the  vagina, 
and  a  perfect  obliteration  of  the  cavity  of  the  vagina. 

Sometimes,  from  malposition  of  the  uterus  itself,  as 
in  falling  of  the  womb.  This  complaint  is  very  gener- 
ally but  a  symptom  of  uterine  congestion,  hypertrophy 
of  the  OS  uteri,  &c.,  but  occasionally  it  is  simply  a 
falling  of  the  womb.  Where  this  condition  exists  to 
any  great  extent,  pregnancy  is  rarely  found.  The  irri- 
tation causes  so  great  a  leucorrhoeal  flow  as  entirely  to 
carry  away  any  semen  deposited.  Still  I  have  seen  a 
case  of  falling  of  the  womb  so  complete  that  the  vagina 
was  completely  everted  and  the  os  literi  was  exposed  to 
view,  yet  the  woman  was  impregnated,  la  verge  de 
Vhomme  dtant  introduite  dans  Vos  ut^ri  mtme.  — 
(Reported  in  Am.  Jour,  of  Med.  Sciences,  Oct.,  1846.) 

Chopart  reports  a.  similar  case,  and  Dr.  Gruhn  of 
Repp  en,  a  like  case  of  prolapsus,  which  accident  how- 


Pi^M'K  m. 


u 


Figg 


T  Sircclair's  Chromo  lith.PhiJ^ 


MALFORMATIONS    OF    THE    VAGINA.  65 

ever  did  not  occur  till  the  fourth  month  of  pregnancy. 
The  vagina  is  also  contracted  in  its  length,  being  a  mere 
fent  or  chink  between  the  labia — in  its  circumference 
— amounting  almost  to  obliteration.  In  one  instance 
recorded,  this  contraction  was  such  as  to  simulate  the 
OS  uteri,  and  the  attending  physician,  examining  per 
vaginam,  supposed  that  he  had  arrived  at  the  external 
OS  uteri  low  down  in  the  pelvis,  and  the  case  was  sup- 
posed to  be  a  falling  of  the  womb. 

I  need  not  add  that  the  presence  of  tumors  or  other 
adventitious  growths  in  the  vagina,  the  rectum,  the 
bladder,  or  in  the  adjacent  cellular  substance,  may  so 
block  up  the  passage  as  to  render  it  impossible,  or 
nearly  so,  for  the  semen  to  fairly  enter  into  the  vagina. 
In  one  case,  where  there  was  chronic  constipation  of  the 
bowels,  the  rectum  was  so  completely  filled,  as  to 
materially  diminish  the  calibre  of  the  vagina,  so  that 
with  the  extra  sensitiveness  of  the  parts,  full  coition 
was  not  eJBfected,  if  possible. 

The  semen  of  the  male  may  fail  to ,  enter  into  the 
uterus.  In  a  few  rare  cases  recorded,  the  vagina,  from 
congenital  malformation,  has  opened  into  the  rectum, 
and  sometimes  it  ends  in  a  cul-de-sac,  leaving  the  uterus 
to  open  either  into  the  cavity  of  the  bladder  or  the 
rectum.  Dr.  Steger,  {Nashville  Journal  of  Medicine 
and  Surgery,  August,  1855),  records  a  curious  mal- 
formation, where  there  ' '  was  no  development  whatever 

5 


66  PATHOLOGY    OF    STERILITY. 

of  the  labia  externa  observable,  nor  even  the  slightest 
trace,  or  indication  by  which  we  should  infer  that  they 
ever  existed ;  about  two  inches  above  the  symphisis 
pubis,  on  the  linea  alba,  there  is  an  opening  from  the 
uterus  not  more  than  an  inch  and  a  quarter  in  length, 
presenting  rather  the  appearance  of  a  smooth  incision, 
than  the  misplaced  pudendum,  and  immediately  above 
which  there  is  a  hirsute  growth  and  a  merely  observa- 
ble development  of  a  mons  veneris.  From  the  external 
opening  of  this  orifice  to  the  os  tincae,  about  two  and 
a  half  or  three  inches,  is  the  vagina  covered  by  a  smooth 
surface  of  mucous  membrane,  the  urethra  perforating  it 
immediately  under  the  deep-seated  fascia."  This  woman, 
a  negro  slave,  was  however,  pregnant,  and  delivered 
by  a  sort  of  cesarian  operation,  which  was  the  enlarging 
this  peculiarly  situated  vagina,  by  a  longitudinal  incision. 


But  having  surmounted  the  obstacles  in  the  vagina, 
peculiar  difficulties  sometimes  occur  impeding  fecunda- 
tion from  disorganizations  in  the  womb  itself — in  the  os 
externum,  the  cavity  of  the  cervix,  the  os  internum,  in 
the  cavity  of  the  body  of  the  womb,  in  the  Fallopian 
tubes,  in  its  fimbriated  extremity,  in  the  ovary. 

In  investigating  these  various  difficulties,  I  shall  have 
occasion  but  to  merely  enumerate  the  occasional  con- 
genital absence  of  the  uterus  itself,  or  the  os  and  cervix 
only,  leaving  the  body  remaining  healthy  (such  doubtful 


DOUBLING   OF   THE   WOMB. 


67 


cases  having  been  reported),  or  the  general  diseases  of 
its  various  tissues,  or  its  appendages,  where  those 
diseases  do  not  afifect  the  interior  portion  with  which 
the  seed  of  the  man  comes  in  contact,  in  its  passage  to 
unite  with  the  ovum.  Such,  for  instance,  are  numerous 
forms  of  tumor,  and  of-  local  or  other  manifestations  of 
constitutional  syphilis,  which  according  to  its  location, 
may  or  not  form  a-  barrier  to  fecundation.  Their 
general  effect,  as  disturbing  the  constitution,  will  be 
referred  to  in  a  distinct  paragraph. 

The  semen  may  fail  to  enter  the  cavity  of  the  womb 
from  an  imperforate  os  uteri,  or  the  alteration  in  the 
passage,  or  its  closure,  by  the  doubling  of  the  womb 


Fig.  18. 


a 


upon  itself,   as  in  the  forms  of  disease,  or  rather  of 
debility,  of  late  recognized  as  much  more  frequent  than 


68  PATHOLOGY    OF    STERILITY. 


was  generally  supposed,  variously  called  (by  refinementr. 
of  nomenclature  more  exact  than  the  appearances  they 
are  supposed  to  represent,)  retro  and  ante-flexion  or 
version. 

In  Fig.  18  we  have  representations  of  various  obli- 
quities of  the  uterus  ;  «,  c,  and  e,  are  of  the  class  called 
flexions,  while  b,  and  d,  are  denominated  versions.  As 
may  be  supposed,  there  are  endless  varieties  and  shades 
of  deviation  from  both  of  these  classes,  and  I  have 
therefore  used  these  terms  synonymously. 

By  reference  to  Plates  II.  and  III.,  the  position  of  the 
uterus  will  be  perceived  in  situ,  and  in  reference  to  the 
other  organs,  Plate  II.  representing  the  womb  in  the 
normal  position,  and  Plate  IV.,  indicating  it  in  a  posi- 
tion, resembling  d  in  Fig.  18. 

This  obliquity,  it  will  be  perceived,  not  only  affects 
the  functions  of  the  uterus,  but  it  also  seriously  militates 
with  the  healthy  action  of  the  rectum  and  bladder,  as 
it  presses  upon  one  or  the  other. 

By  this  accident  the  womb  is  forced  into  an  abnormal 
condition,  as  if  doubled  together,  and  it  may  readily  be 
perjeiyed,  that  the  interior  canal  must  not  only,  be 
sensibly  diminished  in  its  calibre,  but  the  opening  of 
the  OS  must  be  more  or  less  drawn  aside  and  occluded. 
In  these  cases  the  menstrual  fluid  being  secreted  within, 
is  discharged  with  more  or  less  pain,  often  with  very 
great  accompanying  suffering,  by  means  of  the  muscular 
uterine  force.     No  such  force  is  exerted,  or  can  be,  to 


POLYPI    OF    THE    UTERUS.  69 

force  in  the  seminal  fluid,  which  consequently  rarely 
reaches  within  the  uterus.  I  am  convinced  that  this 
obliquity  is  the  present  cause  not  only  of  sterility,  but 
also  of  dysmenorrhoea  in  very  many  cases,  from  the 
number  of  such  instances  which  have  within  a  short 
time  fallen  under  my  observation,  both  in  private  prac- 
tice and  public  charities  :  and  I  am  equally  persuaded 
that  I  have  passed  by  unnoticed,  many  other  similar 
cases,  because  my  attention  had  not  then  been  directed 
to  them. 

Fig.  19. 


Another  form  of  mechanical  obstruction  is  the  pres- 
ence of  tumors,  filling  up  the  orifice  or  some  portion 
of  the  passage.  They  are  of  various  characters,  and 
those  of  the  fibrous  nature,  often  growing  to  an  immense 
size — the  largest  pedunculated  on  record,  as  reported 
by  Dr.  J.  W.  Francis,  weighed  one  hundred  and  one 
pounds.  Polypi,  either  vesicular,  mucous,  or  cellular, 
in  various  localities  affect  this  end.     They  are  very 


70  PATHOLOGY    OF    STERILITY. 

often  not  suspected,  for  the  menstrual  flow  is,  perhaps, 
more  than  ordinarily  free,  certainly  as  much  and  as 
frequent  as  usual.  The  polypus  hangs  by  a  pedicle 
from  the  os,  from  within  the  neck,  within  the  cavity  of 

Fig.  20. 


the  uterus  ;  projecting  into  the  passage  more  or  less, 
and  acting  as  a  valve,  preventing  all  ingress,  but  not 
interfering  with  egress.  {Plate  III,  ^  Figs.  19,  20,  21 
^  22.)  The  vesicular  polypi  are  often  most  insignifi- 
cant in  appearance,  not  larger,  frequently,  than  a  half- 
pea,  (Plate  III,  Fig.  1.)  often  unnoticed  by  the  patient, 
even  passed  over  by  quite  shrewd  medical  men,  whose 
attention  has  not  been  directed  to  th6m — unfelt  by  the 
touch,  and  unobserved  by  the  speculum. 

Often,  however,  they  are  not  perceptible  by  any 
sense,  until  the  os  externum  being  dilated  with  an 
instrument,  discloses  the  little  parasite  concealed  within 
the  cavity,  a  sure  sentinel,  permitting  not  even  the 
proper  occupants  of  the  locality  to  enter  and  pass  in. 
Blood  constantly  exudes  from  these  tumors  for  many 


POLYPI    OF    THE    UTERUS.  71 

months,  until  the  patient's  strength  is  quite  exhausted 
by  this  slow  and  continuous  hemorrhage.  Their  vascu- 
larity may  be  seen  by  reference  to  the  figures  on  Plate 
No.  Ill,  taken  from  Professor  Meigs'  excellent  Essay 
on  the  Acute  and  Chronic  Diseases  of  the  Neck  of  the 
Uterus,  in  the  Transactions  of  the  National  Medical 
Association,  Yol.  vi. 

Other  tumors  may  exist  within  the  substance  of  the 
OS  uteri,  which  may  so  press  upon  the  canal  as  to  close 
it  against  any  entrance. 

Fig.  21. 


Some  six  months  since,  I  saw  a  lady  about  twenty- 
six  years  of  age,  a  patient  of  Dr.  Cyrus  Weeks,  who 
had  never  menstruated,  although  every  four  weeks  she 
was  compelled  by  excessive  pains  in  the  back  and  abdo- 
men, to  keep  her  bed  for  several  days.  She  had  been 
married  about  two  years,  but  without  experiencing  any 
change,  neither  had  she  been  impregnated.  On  examin- 
ation, the  finger  discovered  nothing  abnormal,  and  when 


72  PATHOLOGY   OF    STERILITY. 

passed  into  the  rectum,  the  uterus  appeared  to  be  about 
three  times  its  natural  size.  The  uterine  sound  could 
not  be  passed  through  the  internal  os  uteri.  It  was  con- 
cluded that  a  fibrous  tumor  filled  the  interior  of  the 
uterus,  which  originated  in  the  substance  of  the  uterus 
and  entirely  occluded  the  passage. 

The  presence  of  hydatids  can  scarcely  be  called  a 
cause  of  sterility,  since,  in  the  opinion  of  the  ablest 
pathologists,  as  Desormeaux,  Velpeau,  Orfila,  Milne 
Edwards,  Pouchet,  Meigs,  and  others,  hydatids  are 
commonly  nothing  more  than  a  pathological  degener- 
ation of  the  product  of  conception.  Still  their  presence 
actually  preventing  subsequent  impregnation,  I  have 
mentioned  them  in  connection  with  the  other  causes  of 
sterility. 

Fig.  22. 


One  form  of  disease  which  may  sometimes  be  con- 
sidered as  polypi,  especially  as  polypi  of  the  diminu- 
tive character  above  referred  to,  are  the  ovula  nabothi 
— a  name  originating  from  the  early  supposition  that 


OVULA    NABOTHI.  73 

they  were  abortive  ovules  which  had  attached  them- 
selves to  the  OS  and  cervix  uteri.  Subsequent  writers 
have  spoken  of  them  as  obstructed  follicles  of  the 
mucous  membrane.  Dr.  Whitehead  considers  them  to 
be  glandular  bodies,  and  states  that  he  has  "strong 
reasons  for  believing  that  their  function  is  intimately,  if 
not  solely  concerned  in  the  phenomenon  of  the  venereal 
orgasm."  He  also  says,  "  I  have  been  led  to  regard 
the  nabothean  bodies  as  consisting  anatomically  of  an 
erectile  tissue,  inclosing  a  number  of  cells  and  tubes, 
which  probably  have  a  peculiar  arrangement,  and  are 
highly  organized.  After  the  escape  of  their  contents, 
the  accumulation  and  emission  of  which  appear  to  be 
but  a  momentary  act,  they  immediately  collapse  and 

Fig.  23. 


disappear  from  view."  Dr.  Tyler  Smith,  satisfactorily 
disapproves  this  opinion,  alleging  that  the  difficulty  of 
finding  them  in  the  healthy  state,  is  one  of  the  best 
proofs  of  their  non-existence,  except  as  a  diseased  con- 
dition. He  considers  them  the  origin  of  the  vesicular 
polypi  above  noted.    They  are  in  themselves  little  cysts, 


74  PATHOLOGY    OF    STERILITY. 

rarely  seen  except  in  diseased  states  of  the  os  and 
cervix  uteri.  They  may  be  noted  in  Fig.  23,  where  the 
OS  and  cervix  uteri,  partially  inverted,  show  the  cervical 
rugae.  Two  nabothean  ovules  are  visible,  and  the 
surface  of  the  os  is  eroded  in  patches. 

For  full  dissertations  on  the  pathology  of  these 
tumors,  see  Huguier's  Memoire  snr  les  Kystes  Follicu- 
laires  du  Vagin  ;  M.  Robin's  Memoire  pour  servir  a 
VHistoire  Anatomique  et  Pathologique  de  la  membrane 
muqueux  Uterine,  de  son  Mucus,  de  la  caduquc  et  des 
(Bufs  ou  mieux  glands  de  Naboth,  or  the  able  resume, 
by  Tyler  Smith,  from  whose  work  on  Leucorrhoea,  I 
have  borrowed  Fig.  23. 

By  far  the  commonest  cause  of  Sterility,  as  it  has 
appeared  to  me,  is  from  disease  of  the  os  externum, 
and  particularly  that  form  mentioned  by  Bennett,  and 
deduced  from  the  teaching  of  Recamier,  Lisfranc,  and 
other  French  magnates  of  modern  days. 

The  treatment  of  all  diseases  of  females,  has  been 
immensely  simplified  by  the  discovery  of  the  speculum 
by  Recamier,  and  both  French  and  English  have  written 
much  upon  its  value  and  the  results  gathered  from  its 
use.  Still  they  have  not  laid  stress  upon  its  peculiar 
value,  as  an  adjuvant  for  the  cure  of  sterility. 

Most  barren  women  believe  themselves  in  perfect 
health  ;  at  least  very  many  of  them  do  not  dream  of 
any  local  disease,  which  is  the  cause  of  this  condition. 
They  are  content  with  the  idea  of  personal  idiosyncrasy. 


INTERNAL  CORRESPONDENCE  OF  EXTERNAL  DISEASE.     75 

In  a  large  proportion  of  these  females,  a  speculum 
examination  evinces  a  greater  or  less  degree  of  chronic 
inflammatory  disease  of  the  os  and  cervix  uteri,  and, 
the  cause  and  continued  persistence  of  it  is  easily 
accounted  for  in  many  instances. 

'The  trouble  commences  sometimes  before  marriage, 
sometimes  during  the  "honey-moon,"  sometimes,  and 
very  often  succeeding  an  abortion,  or  after  a  ' '  bad 
getting  up  "  at  childbirth. 

The  cause  of  the  various  forms  of  uterine  disease  is 
certainly  not  entirely  known,  but  my  own  investiga- 
tions have  shown  some  facts  not  generally  recognized. 

First. — There  are  often  originally  internal  manifesta- 
tions corresponding  to  external  cutaneous  affections. 
Were  not  these  facts  demonstrated,  we  might  reasonably 
infer  their  existence  from  the  marked  similarity  which 
exists  between  the  mucous  membrane  of  this  locality 
and  the  skin  ;  this  resemblance  being  much  more  evi- 
dent than  between  the  mucous  membranes  of  other  situ- 
ations, and  the  cutaneous  structure.  The  facility  with 
which,  in  cases  of  prolapsus,  the  exposed  mucous 
membrane  of  the  everted  vagina  takes  the  character  and 
functions  of  the  skin  is  another  corroborating  proof. 

Secondly. — There  are  forms  of  disease  accidentally 
excited,  developed  and  modified  by  the  locality,  of 
general  constitutional  taint. 

First.  —  Every  medical  man  knows  that  small-pox 
and   varioloid   not   only   form   their   pustules   on   the 


76  PATHOLOGY    OF    STERILITY. 

external  skin,  but  also  on  the  internal  mucous  mem- 
branes, and  that  they  and  their  subsequent  cicatrices 
are  noted  on  the  eye-ball,  the  tongue,  the  fauces,  tonsils 
&c.,  and  even  on  the  internal  viscera.  So  also  they  may 
be  observed  upon  the  os  uteri.  Rubeola  is  noticed  on 
the  throat  and  vagina.  Scarletina  exfoliates  the  epider- 
mis, but  the  mucous  membranes  of  the  throat,  ear,  eye, 
vulva,  uterus,  secrete  pus.  Psoriasis  exzema,  and  lichen, 
have  corresponding  types  upon  the  vagina  and  cervix 
uteri.  Hence  have  originated  as  I  have  noted,  many  of 
the  uterine  difficulties.  This  view  I  need  not  develope 
further,  its  probability  will  render  it  scarcely  question- 
able, and  observation  will  endorse  the  bill  of  credit. 

Secondly.  —  Local  scrofulous  disease  is  often  ob- 
served in  the  same  manner  that  we  recognize  local 
cancerous  developments.  A  tuberculous  diathesis 
is  manifested  not  only  by  tubercular  lungs,  tubercles 
in  the  brain,  kidneys,  but  also,  less  recognizable  as 
the  same  disease,  by  tubercles  in  the  bones.  Still  more 
remotely  of  the  same  type,  by  long  eye-lashes;  extreme 
purity  of  skin  ;  peculiar  growth  of  the  nails  ;  a.  ten- 
dency to  slow  glandular  inflammation,  an  1  subsequent 
suppuration  ;  and  likewise,  according  to  my  own  obser- 
vations, by  a  tendency  to  uterine  excitability,  and  con- 
sequently of  divsease, 

That  tuberculosis  or  a  phthisical  disposition  is  mani- 
fested in  uterine  excitabilit}'-,  it  is  useless  to  reason  upon, 
but  the  marked  tendency  to  fecundation  evinced  by 


NECESSITY    OF    EARLY    EDUCATION.  7.7 

the  consumptive  woman  is  universally  conceded.  The 
prolific  disposition  of  those  of  a  cachetic  family, 
although  as  yet  manifesting  no  form  of  this  disease, 
needs  only  to  be  looked  for  to  be  plainly  perceived. 

Be  it  when  it  may,  with  very  rare  exceptions,*  this 
condition  of  things  is  never  corrected,  and  the  disease 
never  disappears,  unless  by  proper  treatment,  or  by  the 
effect  of  some  overwhelming  disease,  diverting  the 
powers  of  nature,  until  after  the  cessation  of  the 
menses,  when  every  hope  of  offspring  has  ceased. 

The  speculum  plainly  discovers  the  lesions,  or  the 
educated  touch — educated  by  the  conjoined  use  of  the 
speculum — may  often  distinguish  the  local  difficulties. 

Scarcely  twenty  years  has  attention  been  paid  to 
these  local  diseases,  and  it  is  only  the  younger  men 
of  the  profession,  taught  to  observe  these  manifestations, 
of  disease,  that  fully  understand  and  recognize  them: 
The  knowledge  of  first  principles,  can,  as  a  general 
thing,  be  properly  and  easily  attained  but  in  comparative 
youth.  The  old  physician  is  slow  to  adopt  new  ideas, 
and  even  were  his  mind  ready  to  entertain  them,  the 
senses  unpracticed  when  in  the  vigor  of  youth  are  dull 
for  the  required  perception.  The  elderly  man  can  never 
bring  his  ear  to  detect  the  nice  distinctions  of  sound  in 
pulmonic  and  cardiac  complaints,  or  the  evidences  of 
foetal  and  placental  circulation  in  pregnant  women. 
The  ear  of  the  old  physician  can  never  be '  but  imper- 
fectly educated. 


78  PATHOLOGY    OF   STERILITY. 

The  eye  is  the  same,  and  the  sense  of  touch  is  equally 
imperfect.  With  the  speculum,  the  aged  vision  may 
indeed  behold  immense  disorganizations,  and  large 
fungous  growths  ;  the  feeble  finger  may  discover  a 
gaping  OS,  or  the  ravages  of  cancer,  but  to  the  true 
eye,  and  the  t actus  eruditus  of  younger  years,  what 
appear  but  trifles  to  the  former,  or  remain  unnoticed 
until  pointed  out,  are  easily  discernible. 

It  is  these  "  trifles  "  not  unfrequently,  I  may  say 
almost  invariably,  in  apparently  healthy  females,  in 
which  consists  the  disease  of  sterility. 

The  OS  and  cervix  uteri,  in  one  or  all  of  its  surfaces, 
exterior  and  interior,  is  the  seM  of  inflammatory 
diseases,  both  acute  and  chronic.  It  is  the  latter  form 
that  immediately  interests  us. 

The  symptoms  of  the  disease  are  dragging  pains  in 
the  back,  in  the  loins,  in  the  thighs,  a  sinking  feeling 
in  the  stomach,  irregularity  of  the  bowels  and  of  the 
menses,  sympathetic  irritation  of  the  stomach,  frequent 
micturition,  loss  of  appetite,  sometimes  vomiting,  occa- 
sionally morning  sickness  simulating  pregnancy,  head- 
aches, great  nervous  susceptibility,  fainting,  spasms, 
great  fatigue  upon  slight  exertion.  These  symptoms  in 
numerous  degrees,  and  variously  modified  in  different 
cases,  are  accompanied  very  generally  by  a  more  or 
less  profuse  vaginal  discharge,  known  as  leucorrhoea, 
whites,  "  a  weakness,"  &c. 

Leucorrhoea  has   been    always   considered  to  be   a 


CHARACTER    OF    LEUCORRHOEA.  79 

disease  of  doubtful  pathology,  but  I  apprehend  that 
before  a  very  long  time,  in  a  work  on  Diseases  of 
Females,  that  name  will  be  recognized  only  as  the 
name  of  a  symptom  of  numerous  fully  recognized 
disorders.  Some  advance  towards  this  result  is  already 
attained,  and  it  still  retains  its  place  as  the  designation 
of  an  afifection,  solely  because  the  advance  of  science 
has  not  yet  recognized  in  one  or  two  classes  of  cases 
only,  the  particular  lesion  upon  which  this  flow  is 
dependent. 

In  some  forms  of  these  complaints,  although  occa- 
sionally of  considerable  apparent  magnitude,  no  dis- 
charge is  perceptible.  Sometimes  there  is  no  discharge 
worthy  of  note.  Occasionally  the  speculum  evinces 
that  this  exhalation  is  very  considerable,  but  as  it  does 
not  escape  from  the  vulva,  we  can  account  for  its  disap- 
pearance in  the  lower  portions  of  the  vagina,  only  by 
its  being  absorbed  in  its  progress  outward. 

The  character  of  this  discharge  is  pathognomonic, 
of  the  locality  from  whence  it  springs.  Dr.  Tyler 
Smith,  of  London,  in  his  memoir  before  the  Royal 
Medical  and  Chirurgical  Society,  April  1852,  and  sub- 
sequently gathered  into  a  volume  under  the  title  of 
"  The  Pathology  and  Treatment  of  Leucorrhoea,^^  and 
Dr.  Brigel,  of  La  Charite,  Berlin,  have  made  full  micros- 
copic and  chemical  investigations  of  this  secretion,  and 
have  thrown  much  light  upon  this  subject. 

According  to  the  latter,  the  secretion  of  the  uterus 
is  always  alkaline,  that  of  the  vagina  and  urethra,  acid, 


80  PATHOLOGY   OF    STERILITY. 

and  that  of  Duverney's  glands  neutral.  If  the  secretion 
is  found  sometimes  acid,  and  sometimes  alkaline,  this 
depends  upon  whether  the  uterus  or  the  vagina  fur- 
nishes the  largest  share.  The  discharge  is,  however, 
almost  always, sour,  as  the  acid  reaction  of  the  vaginal 
secretion  is  too  considerable  to  be  neutralized  by  the 
alkaline  fluid,  &c.  2,  great  viscidity  (Zdhigkeit),  of 
the  secretion  indicates  that  it  is  uterine.  3,  milk-white 
secretion,  that  is  not  viscid  or  filiform,  denotes  simple 
vaginal  catarrh.  4,  a  puriform  condition  results  from 
acute  or  chronic  gonorrhoea,  but  may  also  depend  upon 
other  conditions.  In  the  first  case,  the  urethra,  and 
Duverney's  glands  are  especially  affected,  but  not  so  in 
the  others.  5,  the  microscope  enables  us  to  distinguish 
whether  the  discharge  proceeds  especially  from  the 
uterus  or  the  vagina,  and  also  whether  it  consists 
merely  in  an  increased  separation  of  epithelial  cells 
(simple  catarrh),  Or  is  accompanied  by  the  formation  of 
pus  cells  (blenorrhoea.)  6,  the  author  has  carefully 
sought  for,  without  ever  finding  the  trichonas  vaginalis, 
which  Donn6  states  to  be  characteristic  of  infecting 
fluor  albus  ;  but  the  changed  epithelial  cells,  enclosed 
in  tough  mucus,  bear  a  great  resemblance  to  the 
figures  he  has  given. 

Mons.  Donn^  found  that  in  the  healthy  secretions  of 
the  vagina  and  uterine  canal  the  spermatozoa  lives 
for  a  considerable  period,  but  that  in  certain  morbid 
conditions  they  are  speedily  destroyed.  Dr.  Tyler 
Smith    has    elicited    many   important   facts,    and    his 


PHYSICAL    EXAMINATION    IMPERATIVE.  81 

chemical  examinations  of  the  secretions  from  the 
various  portions  of  the  utero-vaginal  canal,  have 
plainly  shown  that  excessive  acidity  of  the  vaginal 
mucus,  or  increased  alkalinity  of  the  'cervical  mucus, 
are  alike  destructive  to  the  spermatozoa.  Dr.  "White- 
head also  notes  the  same  general  facts. 

The  great  point  pertinent  to  this  investigation,  is, 
if  this  discharge  be  or  not  albuminous.  If  albuminous, 
or  even  partially  so,  then  it  may  be  set  down  as  positive, 
independent  of  further  observation,  that  the  lesion  is 
within  the  os  externum  uteri ;  for  the  glands  of  the 
vagina  do  none  of  them  secrete  albumen ;  they  are 
muciparous  glands,  and  their  exhalations  are  mucus,  or 
if  diseased,  mucus  combined  with  pus. 

On  the  contrary,  the  intra  cervical  glandular  appa- 
ratus secretes  albumen,  with  or  without  pus  combined, 
according  to  their  health  or  diseased  condition. 

Finding  a  profuse  discharge  combined  with  albumen, 
or  great  general  diseased  action  without  external 
discharge,  duty  must  overcome  delicacy,  and  a  physical 
examination  is  imperative,  and  he  who  neglects  this, 
neglects  his  duty,  disregards  the  obligations  which  he 
voluntarily  assumed  on  entering  the  profession,  to  do 
all  in  his  power  to  assuage  the  ills  incident  to  humanity. 
Ignorance  is  no  excuse  in  the  eyes  of  the  law,  on  the 
part  of  the  physician  it  is  unpardonable. 

The  finger  passes  into  the  vagina,  and  reaching  the  os 

6 


82  PATHOLOGY    OF    STERILITY. 

uteri,  may  find  it  in  various  localities  and  conditions — 
low  down  and  anterior,  high  up  and  posterior,  indicating 
either  the  ante  or  retro-flexions  before  referred  to,  or 
prolapsed  by  its  own  weight,  and  the  lax  condition  of 
the  vaginal  walls  resulting  from  its  diseased  condition. 
In  size  it  will  vary  from  a  slight  enlargement  to  an 
immense  hypertrophy,  being  not  unfrequently  many 
times  its  original  size  and  weight.  It  is  this  increased 
ponderosity  that  gives  it  the  phase  of  "  falling  of  the 
womb,"  till  recently  the  only  recognized  symptom.  In 
the  vast  majority  of  cases,  "  falling  of  the  womb  " 
depends  wholly  and  only  upon  this  increased  weight, 
and  this  increase  is  owing  merely  to  causes  which  we 
shall  proceed  to  enumerate.  One  affection  so  induces 
another,  which  itself  excites  a  third,  and  this  reacting 
upon  the  first,  and  so  through  the  chain,  that  it  has 
been  difficult  to  determine  the  great  first  cause. 
Patient  investigation  however,  has.  at  last  found  the 
root  of  the  matter,  and  the  finger  of  the  explorer  ar- 
rives at  it,  when,  upon  the  surface  of  the  hypertrophied 
OS  uteri,  he  feels  a  soft,  unctuous,  velvety  spot.  This  is 
generally  felt  at  and  around  the  os  externum,  occasion- 
ally limited  in  extent,  generally  confined  to  the 
anterior  or  posterior  lip,  but  in  severe  cases  embracing 
and  entirely  covering  the  os  and  cervix  uteri. 

When  limited  in  extent,  the  portions  of  the  os 
surrounding  this  described  spot,  are  often  hardened  in 
their  character,  giving  a  firm,  unyielding  impression  to 


OBSERVATIONS    BY    THE    TOUCH. 


83 


the  touch,  and  the  edges,  the  point  of  union  between 
the  healthy  and  diseased  surfaces,  seem  in  some  cases 
thickened  and  defined. 

The  OS  externum  is  found,  not  as  in  the  healthy  state, 
with  difficulty  admitting  an  intra-uterine  sound,  but  the 
finger  passes  into  the  cavity  to  some  distance,  and  often 
seems  capable  of  being  introduced  up  to  the  fundus  of 

Fig.  24. 


the  uterus  itself;     The  character  of  the  walls  of  the 
neck  of  the  uterus  seem  materially  changed  ;  they  are 


84  PATHOLOGY    OF    STERILITY. 

flaccid  and  easily  dilatable,  so  that  with  ease  a  second 
finger  may  often  be  introduced  by  the  side  of  the 
former.  ' 

Upon  withdrawing  the  finger,  it  will  be  found  covered 
with  a  muco-purulent  discharge,  often  mixed  with 
freshly  exuded  blood. 

To  the  touch  nothing  more  is  capable  of  being 
elicited,  but  the  speculum  throws  a  flood  of  light  upon 
the  matter.  By  its  use  we  perceive  that  what  was  to 
the  finger  soft,  velvety,  is  an  ulceration,  and  the  unc- 
tuous softness  comes  from  the  granulations  of  newly 
forming  substance,  or  the  denuded  papillae.  We  find 
that  invariably  this  ulceration  starts  from  the  cavity  of 
the  OS,  or  at  any  rate  that  the  os  internum  is  always 
involved  in  the  ulcerated  portion. 

From  the  exterior  of  this  ulcerated  surface  proceeds 
the  pus,  the  yellow  ingredient  of  the  leucorrhoeal 
discharge  ;  while  flowing  from  the  os,  a  limpid,  tena- 
cious fluid,  may  be  observed  adhering  with  so  great 
tenacity  that  it  .cannot  be  wiped  away. 

The  ulcer  bleeds,  often  from  the  mere  touch  of  the 
instrument,  or  the  soft  sponge  or  lint  used  to  wipe 
away  the  secretions. 

In  color  the  ulceration  varies,  according  to  the 
character  and  intensity  of  the  inflammatory  action 
going  on,  and  the  condition  of  the  surface.  A  peculiar 
form  is  the  "  raspberry  os"  (see  Plates  I.  and  V.),  so 
called  from  its  general  resemblance  to  that  berry,  and 


RASPBERRY    OS. 


85 


which  in  its  surface  is  nodulated  from  the  exaggeration 
of  the  villi,  till  recently  supposed  to  be  mucous  follicles, 
like  the  inflamed  papillae  of  the  tongue  in  glossitis,  or 
particularly  in  scarletina. 


Fig.  25. 


I  have  called  this  morbid  lesion  an  ulceration,  not- 
withstanding that  Lee  and  some  others  deny  that  it  is 
such.  They  state  that  there  is  no  lesion  except  of 
epithelium,  and  that  abrasion  would  be  a  better  term  to 
apply  to  it.  According  to  the  teachings  of  my  youth, 
an  ulcer  is  but  "  a  solution  of  continuity  attended  with 
a  secretion  of  pus  ;"  and  the  condition  of  things  answers 


86 


PATHOLOGY    OF    STERILITY. 


to  this  statement.  In  the  heat  of  unworthy  party 
and  unprofessional  controversy,  the  London  physicians 
have  left  the  main  issue  of  facts,  and  have  disputed 
merely  about  names.  The  condition  of  things  is  how- 
ever, as  I  have  stated,  call  it  by  such  names  as  you 
will. 

Fig.  26. 


Fig.  24  is  a  circumscribed  ulcer  of  the  os  uteri, 
magnified  twenty  diameters,  showing  the  removal  of 
the  epithelium  and  erosion  of  the  villi.  The  ulcer  is 
surrounded  by  a  fringe  of  enlarged  villi.  Figs.  25  and 
26  represent  respectively  these  villi,  of  the  os  uteri  mag- 
nified two  hundred  and  twenty  diameters,  and  of  the 
cervix  uteri  of  one  hundred  diameters,  covered  with 


ULCERATIONS    OF    OS    AND    CERVIX. 


87 


epithelium.  These,  till  recently,  were  considered  to 
be  the  enlarged  mucous  follicles,  on  the  authority  of 
Buschke,  who  stated  that  these  follicles  which  are 
numerous  at  the  ostium  vaginae  became  more  frequent 
as  the  mucous  membrane  approached  the  cervix  uteri. 
Paul  Dubois  states  that  M.  Girald^s,  the  able  anatomist 
was  unable  to  discover  any  in  the  upper  part  of  the 
vagina. 

*  Fig.  27. 


On  examination  of  these  villi,  which  may  often  be 
seen   with  the   naked   eye,    like    the    papillse    of  the 


88  PATHOLOGY    OF    STERILITY. 

tongue,  they  are  found  to  consist  each  of  a  looped 
blood-vessel,  which  may  be  seen  passing  to  the  end  of 
the  villus  and  returning  to  its  base  (Figs.  26  and  26), 
where  it  inosculates  with  the  neighboring  villi.  Seen 
in  profile  (Fig.  27),  they  evidently  project  above  the 
surface,  forming  an  irregular  fringe  upon  the  edge,  and 
as  a  whole,  are  not  unlike  the  "  pile  "  of  velvet. 

From  the  anatomy  of  this  morbid  condition  of  the 
parts,  we  do  not  wonder  at  the  readiness  with  which 
these  surfaces  bleed  upon  the  slightest  touch,  or  even 
from  the  friction  caused  by  the  gentlest  exercise. 

More  particularly,  it  is  to  be  noted  that  in  that  form 
of  ulceration  or  epithelial  abrasion  already  alluded  to, 
as  called  the  "  raspberry  os,"  os  framboisee,  sterility  is 
its  constant  accompaniment,  and  this  is  the  result  of 
the  observed  fact  that  the  disease  seems  to  originate 
within  the  cavity  of  the  os,  and  spreads  outward  upon 
the  external  surface  of  the  os  and  cervix. 

This  is  one  of  the  most  ordinary  forms  of  uterin^e 
disease  in  females  of  leisure,  those  who  have  time  to  be 
sick,  and  in  those  of  the  laborious  class,  whose  employ- 
ment is  of  a  sedentary  character.  It  is  therefore  very 
common  in  private  practice,  and  comparatively  rarely 
seen  in  our  cliniques,  dispensaries,  and  other  public 
institutions,  and  then  principally  confined  to  seam- 
stresses and  the  like.  I  account  for  this  from  the  fact 
that  the  poor  washerwoman  is  obliged  by  her  necessities, 
to  be  active,  and  this  slight  form  of  disease,  neglected 


PHTHISIS  PRODUCED  UPON  LEUCORRHOEA.     89 

in  its  origin,  is,  by  the  friction  against  the  vaginal  walls, 
increased,  till  a  more  serious  form  of  difficulty  ensues, 
which  alone  brings  her  to  the  public  charities. 
While  recently  attending  the  obstetric  clinique  of  my 
esteemed  friend,  the  erudite  Professor  of  Obstetrics  in 
the  New  York  Medical  College,  Dr.  B.  Fordyce  Barker, 
I  was  happy  to  hear  these  views  confirmed,  and  there 
first  publicly  stated.  So  important  have  I  deemed 
them  in  connection  with  this  subject,  that  I  have 
thought  it  proper  to  enlarge  upon  this  form  of  papillary 
hypertrophy,  looking  like  morbid  granulations,  and 
to  exemplify  it  more  fully  by  the  cuts  borrowed 
from  Tyler  Smith's  "  Pathology  and  Treatment  of 
LeucorrhoRa,''^ 


Were  this  the  proper  place,  I  would  present  my 
views  supported  by  facts  relative  to  the  development 
of  phthisis,  superinduced  or  developed  by  the  wasting 
effects  of  the  discharges  consequent  upon  this  form  of 
uterine  trouble. 

It  is  well  known  that  females  of  a  strumous  habit 
are  particularly  subject  to  leucorrhoeal  discharges,  and 
consequently  to  uterine  disorganization.  In  my  attend- 
ance at  the  Northern  Dispensary,  it  has  not  unfre- 
quently  occurred  that  a  patient  was  under  the  care  of 
Dr.  Cammann  for  cough  and  disease  of  the  lungs,  and 
at  the  same  time  I  was  topically  treating  the  uterine 


90  PATHOLOGY    OF    STERILITY. 

difficulty.  Sir  Charles  Clarke  noted  that  women  in 
whom  the  glandular  system  is  more  active  than  usual, 
are  affected  with  leucorrhoea.  Dr.  Tyler  Smith  says 
that  leucorrhoea  is  common  in  consumptive  patients, 
but  not  sterility.  Dr.  J.  W.  Francis  has  noted  an 
hereditary  tendency  from  constitutional  debility.  Mr. 
Anderson,  in  the  Association  Journal,  places  leucor- 
rhoea as  a  symptom  of  phthisis. 

A  state  of  general  anaemia  probably,  by  interfering 
with  the  maturation  of  the  ovules  in  the  ovaria,  is 
always  unfavorable  to  fecundation,  and  when  this 
condition  advances  to  amenorrhoea,  and  chlorosis,  the 
function  of  ovulation  is  always  suspended.  Fecund- 
ation is  not  incompatible  with  ulceration  of  the  os 
externum.  We  often  find  immense  hypertrophy  of 
this  portion  covered  with  extensive  ulcerations, 
bathed  with  pus,  where  conception  has  occurred  time 
after  time.  Occasionally,  too,  pregnancy  with  such 
local  condition  will  run  its  full  course  in  safety, 
but,  far  more  generally,  abortion  or  premature  delivery 
is  the  result.  Particularly  is  abortion  apt  to  ensue 
where  there  is  accompanying  fissure  of  the  os  (See 
Plate  Y.,  Fig.  1).  This  form  of  abortion,  which  is  not, 
although  pertinent,  within  the  scope  of  this  treatise,  I 
have  described  in  a  paper,  entitled  **  Uteri?ie  Haemor- 
rhage "  in  the  '^ American  Medical  Monthly,^-  June,  1855. 

But  while  fecundation  is  possible,  although  improba- 
ble, in  the  great  number  of  instances  where  such  ulcer- 


ALBUMINOUS  PLUG  OF  THE  OS  UTERI.       91 

ative  disorganization  exists,  it  is,  I  imagine,  if  not 
utterly  impossible,  at  least  nearly  so,  where  there  is 
this  thick,  glairy,  albuminous  discharge  blocking  up  the 
OS  externum. 

To  this  point  I  am  anxious  to  draw  especial  attention, 
because  it  has  been  heretofore,  generally,  if  not  univer- 
sally, overlooked  by  practitioners.  The  only  recogniz- 
able morbid  appearance  in  many  cases  of  confirmed 
sterility,  is  this  exudation  from  the  os  externum  ;  this 
thick,  tenacious,  firmly-adhering  collection  of  albumen, 
which  we  cannot  wipe  away  with  a  piece  of  lint, 
nor  draw  away  .with  a  forceps,  unless  coagulated  and 
solidified  by  chemical  change,  effected  in  its  character 
by  local  application.  It  would  seem  from  its  tenacity, 
impossible  for  the  most  vigorous  spermatozoa,  to  pass 
through  this  substance,  and  as  we  shall  show,  equally 
difficult  to  pass  between  it  and  the  internal  surface  of 
the  OS. 

Dr.  Tyler  Smith,  op.  cit.,  and  Professor  Meigs,  in  his 
^^  Acute  and  Chronic  Diseases  of  the  Neck  of  the  Uterus," 
recognize  this  appearance  ;  but  the  former,  without 
connecting  with  it  its  most  invariable  concomitant  of 
barrenness,  and  the  latter  passing  it  by  so  casually  as 
to  deprive  his  observations  and  remarks  of  much  of 
their  proper  force. 

He  says  : — "  But  in  cases  where  a  thick  and  highly 
viscid  string  of  mucus  is  constantly  exuding  from  the 
OS  uteri,  we  can  easily  understand  that  the  ascent  of 


92  PATHOLOGY    OF    STERILITY. 

the  spermatic  particles  thrbugh  the  cervical  neck  may 
be  impeded  mechanically." 

Bennett  in  his  invaluable  work,  says: — "It  is  diffi- 
cult to  determine  precisely,  in  what  way  inflammation 
and  ulceration  of  the  neck  of  the  uterus  occasion 
sterility,  although  careful  and  lengthened  observation 
enables  me  to  assert  most  confidently  the  fact.  *  * 
The  cause  of  sterility  may  be  removed  by  curing  the 
inflammatory  disease  to  which  it  owes  its  origin." 

Besides  the  external  visible  ulcerations  of  the  cer- 
vix, we  often  find  instances  where  the  os  externum 
is  of  natural  size  and  appearance,  except  a  slightly 
increased  redness,  and  accompanied  by  this  plug  of 
albumen  ;  and  in  other  cases,  finding  the  os  enlarged, 
admitting  the  finger  to  the  first  joint.  In  these  latter, 
however,  the  disease  is  so  great  that  it  is  easily  recog- 
nizable, but  the  discharge  so  profuse,  that  the  peculiar 
albuminous  plug  is  rarely  seen  blocking  up  the  passage. 

Ocular  examination  of  the  cavity  of  the  os  uteri  is 
,  easily  made.  In  the  cases  where  the  local  disease  is 
great,  without  the  further  aid  of  any  instrument,  the 
gaping  lips  of  the  os  will  plainly  show  the  inflammatory 
action  within  (See  Plates  I.  and  Y.).  In  other  cases  it 
may  be  necessary  to  separate  the  lips,  by  lifting  the 
upper  border  with  the  uterine  sound,  or  more  forcibly 
expanding  the  passage  by  means  of  the  blades  of  long 
uterine  forceps  or  the  speculum  of  the  os  uteri. 

A  very  ingenious   instrument  for   this   purpose    is 


EXAMINATION    OF    THE    OS    UTERI. 


93 


made  by  Mr.  Tiemann,  the  well-known  surgical  instru- 
ment maker,  Chatham  St.,  N.  Y.,  which  well  answers  this 
purpose,  separating  the  lips  of  the  os  uteri,  and  efifectu- 
ally  displaying  its  interior  (Yide  Fig.  28). 


Fig.  28. 


In  most  instances  it  will  be  found  difficult  to  observe 
the  internal  disorganization,  but  without  being  seen, 
the  presence  of  the  albuminous  plug  will  be  patho- 
gnomic of  the  existing  disease.  In  the  forms  where  the 
vision  can  plainly  observe  the  morbid  action,  one 
manifestation  of  disease  is  always  recognizable,  viz. 
the  same  inflammatory  affection  observed  on  the 
external  surface  of  the  os,  modified  only  by  the 
difierent  structure  affected. 

The  true  mucous  membrane  which  begins  at  the 
cervix  uteri  and  covers  the  os  uteri  in  its  vaginal  por- 
tion is  continued  through  the  canal  of  the  cervix,  and  is 
reflected  over  the  internal  surface  of  the  womb  ;  but 
below  it,  in  the  cervical  canal,  lie  numerous  albumen- 
secreting  glands,  whose  office  is  apparent  in  the 
abundant  exhalations  attending  labor.     At  the  men- 


94  PATHOLOGY    OF   STERILITY. 

strual  period  and  at  seasons  of  sexual  intercourse,  these 
glands  are  also  active,  and  a  profuse  emission  of  fluid 
appears  to  take  place.  Under  certain  circumstances, 
from  too  frequent  and  inordinate  sexual  congress,  as 
seen  especially  in  prostitutes  ;  from  the  local  injury  of 
the  parts,  as  often  visible  as  the  consequence  of  the 
too  forcible  entrance  of  the  male  organ  with  the  new- 
married  ;  from  the  effect  of  prolonged  and  fatiguing 
exercise  ;  dancing  ;  of  weighty  dress  ;  of  severe  cold, 
arresting  the  secretions  suddenly,  at  a  menstrual 
period  ;  from  prolonged  irritation  from  the  friction  of 
the  cervix  against  the  rectum  torpid  and  overloaded  ; 
•  from  a  similar  state  of  things  caused  by  the  retained 
contents  of  the  bladder  in  extra  delicate  ladies,  a  more 
or  less  severe  and  extensive  inflammatory  action  takes 
place,  and  the  result  not  unfrequently  observed  as  a 
sequela,  is  the  chronic  irritation,  if  you  please  so  to 
denominate  it,  or  inflammation  of  the  local  glandular 
apparatus,  the  glandulae  nabothii.  "Where  the  disease 
is  slight,  the  increased  discharge,  its  viscidity,  its  ten- 
acity are  the  most  manifest  indications,  as  I  have  stated. 
They  are  not  accompanied  by  any  symptoms  sufficient 
to  draw  the  attention  of  the  sufferer  to  the  part. 
There  may  be  no  pain  in  the  back,  loins,  thighs,  no 
debility ;  but  there  is  enough  disease  to  prevent  con- 
ception, and  simply  from  the  mechanical  cause  before 
mentioned. 

This  is  a  general  relaxation  marked  by  the  flaccid  con- 


PROPORTION  OF  CURABLE  CASES. 


95 


dition  of  the  uterus,  a  patulous  "  feel  "  to  the  os,  the 
mouth  being  more  or  less  enlarged,  and  the  cavity  of 
the  canal  open,  resembling  the  appearance  seen  in  Fig. 
24.     Contrasting  this  with  Fig.  4,  the  abnormal  condi- 


Fig.  29. 


tion  is  palpable.  Such  a  condition  of  the  os  and  cervix 
will  be  manifested  by  little  general  symptoms  other 
than  debility,  albuminous  leucorrhoea,  and  profuse 
menstrual  discharges,  and  consequent  sterility. 

The  great  majority  of  the  women  who  say  that  "  they 
are  in  perfect  health,  and  that  they  do  not  know  why 
they  have  no  children,"  are  in  exactly  this  situation; 
which,  as  I  shall  show  hereafter,  is  curable  in  more  than 
ninety-nine  cases  in  a  hundred,  where  no  complications 
exist,  or  where  no  organic  changes  have  resulted  during 


96  PATHOLOGY    OF    STERILITY. 

the   many  years  which  may  have    elapsed   since   the 
trouble  commenced. 

In  certain  cases,  the  interior  of  the  cervix  uteri 
shows  more  than  this  local  irritation  ;  there  is  marked 
ulceration,  or  this  has  passed  still  further,  the  ulcera- 
tion has  been  cured,  leaving  in  its  cicatrization  a 
diminution  of  the  calibre  of  the  canal,  a  local  stricture 
of  its  whole  course,  or  simply  of  the  os  externum,  or 
the  OS  internum. 

A  very  generally  present  symptom  of  this  condition 
of  things  is  dysmenorrhoea.  Pain  in  menstruation 
may  occur  from  several  causes  ;  from  ante-version, 
retro-flexion,  &c.,  as  already  stated  ;  but  in  far  the 
greater  majority  of  cases,  it  will  be  found  to  arise  from 
the  less  serious  difficulty — because  more  easily  and 
surely  curable — of  local  stricture. 

Among  the  married,  lacerations  of  the  os  and  cervix 
in  a  first  confinement  are  not  unfrequently  followed  by 
subsequent  barrenness.  The  accompanying  symptoms 
being  those  of  dysmenorrhoea,  and  the  severest  forms  of 
uterine  disease,  profuse  leucorrhcea,  &c.  Examination 
shows  immense  hypertrophy  (in  some  cases  the  enlarged 
OS  becoming  too  voluminous  to  be  entirely  displayed  at 
one  view  by  a  four-bladed  speculum) ;  the  fissures,  often 
two  or  three  in  number,  extending  an  inch  or  two 
through  the  neck  towards  the  body  of  the  uterus,  their 
edges  uncicatrized,  the  whole  observable  organ  highly 
injected,  and  the  entire  apparatus  bathed  in  a  profuse 


MEMBRANE    OF    DYSMENORRHOEA.  97 

and  often  fetid  muco-purulent  discharge.  In  the  year 
1852,  I  divided  a  cartilaginous  cervix  in  order  to  effect 
delivery  at  the  full  time .  ( Vide  American  Journal  of  Med- 
ical Sciences,  Julij,  1852.)  The  woman  has  never  since 
been  pregnant,  and  as  she  complains  of  these  symptoms 
I  do  not  doubt  that  a  physical  examination  would 
evince  the  disorganizations  above  enumerated.  I 
regret  not  being  able  to  present  a  drawing  of  this  con- 
dition, although  it  would  doubtless  appear  exaggerated 
to  any  one  not  having  noted  its  actual  existence  in 
nature. 


Passing  beyond  this  point,  the  cavity  of  the  uterus 
proper  has  divers  ills  and  affections,  many  of  which 
are  not  yet  fully,  if  at  all,  known. 

I  have  noted,  in  the  preceding  chapter,  that  at  the 
time  of  menstruation,  the  interior  mucous  membrane 
of  the  uterus  undergoes  a  peculiar  development, 
whether  impregnation  occurs  or  not,  in  order  to  fit  it 
for  the  reception  of  the  ovum. 

In  some  forms  of  disease  this  action  becomes  a 
diseased  one,  and  the  consequence  is,  the  so-called  false 
membrane  of  dysmenorrhoea.  On  the  contrary,  this 
uterine  development  may  be  deficient  from  various 
causes,  such  as  sickness,  general  weakness,  local  cir- 
cumstances, &c.  The  defective  or  absent  formation  of 
this   uterine    mucous  membrane   is   most   probably  a 

7 


98  PATHOLOGY    OF    STERILITY. 

frequent  cause  of  sterility,  especially  if  all  the  ordi- 
narily observable  conditions  of  menstruation  be  present. 
An  egg  is  discharged  normally,  and  may  even  be  as 
regularly  impregnated,  but  it  meets  no  proper  nidus  in 
the  uterus. 

There  are  other  internal  dijQficulties  which  are 
swallowed  up  under  the  generic  title  of  catarrh  of  the 
womb.  This  is  of  the  same  character  as  the  affections 
of  which  we  have  been  speaking,  consisting  of  a  slow 
inflammatory  action,  with  the  development  of  spots 
of  profuse  granulations,  accompanied  by  the  ex- 
cretion of  a  muco-purulent  fluid,  or  of  blood,  by 
excessive  haemorrhages  at  the  menstrual  period,  at 
intermediate  occasions  of  unusual  fatigue,  sexual 
excitement,  &c.  Acute  local  congestion,  as  in  metritis, 
&c.,  is  not  unfrequently  followed  by  chronic  disease  of 
this  nature. 

A  more  full  development  of  these  granulations,  and 
their  subsequent  more  or  less  perfect  organization  con- 
stitutes tumors  and  polypi  of  the  uterus — afi'ections 
already  alluded  to,  but  which  in  their  full  consideration 
do  not  enter  into  the  plan  of  this  work. 

Inflammation  of  the  womb,  either  total  or  partial,  is 
sometimes  though  rarely  followed  by  a  partial  or  entire 
obliteration  of  the  cavity  of  the  uterus,  from  the  adher- 
ence of  the  inner  mucous  membrane,  lining  it. 

The  womb  is  occasionally  ossified.  In  the  valuable 
collection  made  by  Dr.  John  W.  Francis,  of  New  York, 


DISEASES   OF    THE   FALLOPIAN    TUBE.  99 

was  the  ossified  uterus  of  a  woman  who  was  never 
impregnated,  four  inches  long,  by  about  two-and-a-half 
in  thickness.  Ossifications  of  this  organ  in  virgins  are 
very  rare,  and  we  think  no  other  case  than  this  is 
known,  although  I  have  seen  several  uteri  with  their 
contents,  a  foetus,  &c.,  apparently  near  its  full  time, 
forming  an  immense  ossified  mass  in  the  pelvis  where  it 
had  remained  for  many  years. 

In  rare  instances  there  are  found  rupture,  obliter- 
ation, strictures,  and  more  or  less  severe  inflammatory 
action  in  the  Fallopian  tubes.  These  diseases  are 
more  generally  found  at  the  two  extremities  of  the 
tubes,  because  inflammatory  action,  the  origin  of  all 
thes6  difficulties,  rarely '  arises  from  the  middle  of  the 
tube,  unless  in  consequence  of  some  external  violence 
and  consequent  injury,  but,  either  from  the  uterus,  or 
from  the  less  passive  portion,  the  fimbriated  extremity. 

Tyler  Smith,  in  noting  that  the  glandulae  nabothse 
were  present  in  the  cavity  of  the  cervix,  the  muscular 
walls  of  the  uterus,  and  the  broad  ligaments,  says  :  "I 
have  repeatedly  observed  that  in  cases  where  the 
nabothean  bodies  are  met  with,  small  cysts  are  found 
in  the  course  of  the  Fallopian  tube,  or  at  its  fimbriated 
extremity." 

Stricture  of  the  uterine  end  of  the  Fallopian  tube  is 
supposed  to  be  left  as  a  solitary  evidence  of  previous 
disease,  and  as  thus  isolated,  we  have  had  it  described 
by  some  celebrated  Europeans  ;  but  while  we  are  ready 


100  PATHOLOGY    OF    STERILITY. 

to  recognize  the  fact  that  such  local  affection  does  exist, 
and  the  occasional  occurrence  of  a  foetus  being  devel- 
oped in  the  tube,  authenticates  it,  we  feel  that  except 
when  some  unusual  dilatation  or  organic  change  in  the 
OS  uteri  co-exists,  no  method  of  exploration,  can  with 
any  definite  approximation  at  certainty,  demonstrate 
its  presence.  Of  this  we  shall  speak  more  fully  under 
the  head  of  Treatment. 

Disease,  deformity,  and  misplacement  of  the  fimbri- 
ated extremity  may  and  do,  not  very  unfrequently, 
present  a  fatal  bar  to  fecundity. 

Inflammatory  action,  as  an  acute  affection  originating 
in  the  extremity,  is  perhaps  somewhat  rare.  Still,  m 
common  with  the  entire  tube,  and  the  entire  genital 
apparatus,  it  is  at  regular  monthly  intervals  subject  to 
a  turgescence  and  excitation  which  in  consequence  of 
certain  untoward  influences  may  take  on  irritative  and 
inflammatory  action,  followed  by  occlusion  of  the 
patulous  mouth  ;  first,  by  the  extremities  closing  upon 
themselves  ;  secondly,  by  the  extremities  being  agglu- 
tinated to  the  ovary  ;  thirdly,  by  the  extremities  ^being 
permanently  fastened  to  some  portion  of  the  abdominal 
cavity  at  a  distance  from  the  ovary. 

If  the  mouth  of  the  Fallopian  tube  be  permanently 
closed  by  the  deposition  of  coagulable  lymph,  or  the 
adhesion  of  its  sides,  nothing  can  by  any  possibility 
pass  through  it.  Menstruation  ci  dit  may  occur,  but 
the  discharge  will  consist  simply  of  the  excretions  from 


DISORDERS    OF    THE    FIMBRIATED    EXTREMITY.  101 

that  portion  of  the  tube  below,  from  the  cavity  of  the 
womb,  OS  uteri,  vagina,  &c.  No  ovum  can,  by  any 
possibility,  pass  through  any  of  these  cavities. 

If  the  extremity  of  the  Fallopian  tube,  in  its  natural 
prehensile  situation  of  clasping  the  ovary,  be  immova- 
bly attached,  by  inflammatory  action  either  within  itself 
or  of  the  body  of  the  ovary,  a  fortunate  accident  might 
cause  a  Graafian  vesicle  to  be  so  located  that  it  might 
in  breaking,  discharge  its  ovum  directly  into  the  ever 
ready  mouth  of  the  tube  ;  but  if  the  ovum  be  dis- 
charged either  to  one  side  or  the  other,  it  falls  void 
into  the  oavity  of  the  abdomen,  where  in  most  cases  it 
perishes,  is  absorbed,  and  disappears. 

Inflammatory  action  at  some  other  than  the  men- 
strual period,  may  attack  the  fimbriated  extremity,  or 
a  local  inflammation  from  peritonitis,  hernia,  or  ex- 
ternal injury,  may  exist  in  the  vicinity,  and  may  not 
only  withdraw  the  extremity  from  its  propinquity  to 
the  ovary,  but  it  may  fill  up  the  intervening  space,  or 
permanently  fasten  the  extremity  to  some  portion  of 
the  interior  of  the  abdominal  cavity  remote  from  the 
ovary. 

Small  polypi  may  possibly  exist  in  the  course  of  the 
canal,  as  in  all  other  mucous  passages,  although  I  do 
not  know  that  any  have  ever  been  demonstrated  as 
having  been  noticed,  and  small  tumors,  filling  up  the 
passage. 

But  a  more  formidable  source  of   sterility,   is   the 


102  PATHOLOGY   OF   STERILITY. 

forcible  withdrawing  of  the  fimbriated  extremity  from 
the  ovary.  Tumors  may  be  developed  and  exist  in  the 
tube,  or  in  the  adjacent  broad  ligaments.  These  often 
grow  to  a  large  size,  and  the  more  or  less  accompanying 
inflammation  may  not  only  effect  the  disorganizations 
before  alluded  to,  but  also,  merely  mechanically  in  their 
growth,  they  may  lift  up  and  draw  away  the  extremity 
from  the  possibility — left  in  a  healthy  state — of  uniting 
with  the  ovary  in  its  connected  duties.  Hernia  of  the 
ovaries  may  also  isolate  them  from  the  reach  of  the 
fimbriated  extremity. 

These  are  not  theoretical  conditions,  even  if  the 
ascribed  results  be  fanciful,  for  I  have  seen,  and  doubt- 
less many  others  are  conversant  with,  such  morbid 
appearance.  A  notable  case  was  lately  at  the  Wo?na?i^s 
Hospital  of  this  city,  under  the  care  of  my  highly 
esteemed  friend  Dr.  Sims,  where  the  tumor  in  its 
growth  drew  up  the  uterus,  so  that  its  fundus  was 
distinctly  felt,  little,  if  any,  above  the  natural  size, 
midway  between  the  os  pubis,  and  the  umbilicus,  and 
springing  from  it,  the  ovary  was  distinctly  recognizable 
through  the  abdominal  parietes.  Yaginal  examination 
detected,  as  far  off  as  could  be  reached,  the  os  uteri, 
made  doubly  evident  by  the  other  hand  being  simul- 
taneously placed  on  the  fundus.  In  order  that  this 
state  of  things  should  exist,  the  neck  of  the  uterus 
must  have  been  necessarily  materially  elongated.  If 
the  fimbriated  extremity  remained  in  its  normal  situa- 


DISEASES    OP    THE    OVARIES.  103 

tion,  it  seems  scarcely  possible  that  it  could  come  into 
contact  with  the  ovary  at  menstruation. 


Finally,  to  finish  the  causes  why  sterility  occurs  ;  the 
semen  of  the  male  or  its  vital  principle  may  fail  to 
meet  the  ovum  of  the  female,  from  degeneration  of  the 
ovaries  proper.  In  some  instances,  this  organ  is 
entirely  wanting  from  congenital  malformation,  or  it 
may  be  present,  but  so  atrophied  as  to  be  powerless,  or 
so  disorganized,  that  the  ovum  itself  is  unformed. 
Previous  inflammatory  action,  either  acute  or  chronic, 
may  have  forever  destroyed  all  efficient  action  on  the 
part  of  the  ovary.  Henceforth  it  is  an  useless  organ, 
and  having  no  service  to  perform,  it  withers,  becomes 
atrophied,  and  often  but  a  trace  remains. '  This  con- 
dition is  marked  with  the  healthy  aged ;  less  so,  but 
still  sufficiently  perceptible,  with  the  diseased  young. 

I  attended  a  young  girl  in  the  last  stages  of  an  acute 
inflammation  of  the  ovaries,  where  they  had  gone  on 
to  suppuration.  One  ruptured  into  the  cavity  of  the 
peritoneum.  A  post-mortem  showed  that  it  was  of 
immense  size  ;  the  abscess  in  the  other  was  unbroken, 
and  contained  a  quart  of  pus.  This  state  of  things  was 
not  necessarily  fatal.  Had  she  recovered,  it  would 
have  been  difficult  for  one  to  imagine  a  possibility,, 
after  such  thorough  disorganization,  of  subsequent 
impregnation. 


104  PATHOLOGY    OF   STERILITY. 

Ovarian  tumors  of  various  characters,  benign  and 
malignant,  dropsies,  &c.,  often  occur,  which  not  only 
destroy  the  nature  and  powers  of  the  ovary,  but  as  in 
the  case  of  tumors  exterior  to,  and  without  the  organ, 
draw  away  and  alienate  the  ovary,  so  that  the  fimbri- 
ated extremity  may  not  meet  it,  as  above  stated. 

Even  if  there  by  chance  remains  a  portion  of  the 
ovary  uncontaminated  by  the  disease,  sufficient  to 
eliminate  a  healthy  ovum,  the  locale  of  the  discharge 
may  be  incorrect,  and  the  Graafian  vesicle  may  per- 
chance break  into  the  sack  containing  the  dropsical 
fluid,  and  thus  be  lost. 

Chronic  ovaritis  is  a  form  of  disease  much  spoken  of 
by  certain  writers,  but  one  which  I  am  inclined  to 
consider  of  rare  occurrence.  I  think  that  in  most  cases 
where  such  an  affection  is  considered  to  exist  before 
death,  the  difficulties  are  of  a  different  nature,  and 
when  apparently  discovered  in  autopsies,  it  is  rather 
the  disorganizations  produced  by,  and  subsequent  to 
acute  inflammation  which  are  mistaken  for  the  evidences 
of  a  chronic  inflammatory  state. 

So,  too,  we  hear  of  neuralgia  (Gibert),  and  rheuma- 
tisms of  the  uterus  and  appendages,  which  likewise 
seem  to  be  but  long  names  given  to  obscure  diseases, 
heretofore  little  known,  to  hide  the  real  ignorance 
respecting  their  pathology. 


INFLUENCE    OF    PINGUIDITY.  105 

And  here,  while  speaking  of  the  physical  changes 
which  are  the  cause  of  sterility,  I  will  allude  to  one 
condition  which  is  vaguely  enough  considered,  both 
popularly  and  by  the  profession,  to  be  alike  the  cause 
and  consequence  of  barrenness.  "Ah!  she's  getting 
too  fat  to  have  children,"  is  a  frequent  remark  ;  but 
that  pinguidity  should  be  opposed  to  fecundation  is  not 
yet  proved,  or  why  this  condition  should  interfere  with 
conception,  has  never  been  stated. 

We  know  that  when  a  woman  has  passed  her  grand 
climacteric,  if  spare  before,  she  is  quite  apt  to  become 
fleshy  subsequently  ;  and  this  change  has  sometimes 
been  supposed  to  result  from  the  transformation  into 
fat  of  the  blood  and  fluids  discharged  monthly.  True, 
we  do  not  know  how  great  a  tax  upon  the  animal 
economy  it  may  be,  to  create  that  most  subtle  human 
extract — the  ovum  ;  but  further  than  that  we  do 
know,  that  the  quantity  of  blood,  &c.,  lost  at  such 
periods,  is  entirely  insufficient  to  form  the  fat  or 
account  for  the  great  increase  in  flesh,  when  this  flow 
is  arrested. 

More  than  this,  the  menstrual  flow  is  not  arrested 
in  these  cases,  and  is  often  increased  with  the  increase 
in  robustness,  and  some  more  efficient  and  probable 
evidence  of  its  being  a  consequence  of  sterility,  is 
wanted  to  make  this  view  appear  probable. 

In  many  instances  where  fatness  is  present,  the 
woman  has  had  one   or  two    children,   and  then  the 


106  PATHOLOGY   OF    STERILITY. 

sudden  increase  in  size  and  weight  ensues,  and  with  it, 
subsequent  barrenness ! 

I  offer  as  a  plausible  reason,  and  leave  it  for  those 
who  are  enabled  to  make  autopsies,  to  verify  the  truth 
of  the  statement,  that  the  deposition  of  fat  in  the 
abdomen  around  the  intestines,  genital  apparatus,  in 
the  omentum,  has  an  effect  similar  to  that  just  men- 
tioned, caused  by  tumors  in  that  neighborhood.  We 
all  recognize  the  fact  that  the  actions  of  the  heart  are 
manifestly  impeded,  and  sometimes  entirely  arrested, 
by  the  deposition  of  the  fat  in  and  around  it.  I  con- 
sider that  the  unusual  deposit  of  fat  around  the  uterus 
and  ovary,  not  unfrequently  bends  down  the  Fallopian 
tubes,  envelopes  and  obscures  the  ovaries,  and  offers  an 
effectual  barrier  to  the  union  of  the  ovum  and  the  male 
fertilizing  principle. 

In  some  cases  of  extreme  pinguidity,  the  deposit  in 
the  abdomen  has  had  the  effect  of  adding  a  great 
weight  to  the  uterus,  and  to  press  this  organ  down  into 
the  pelvic  strait,  sometimes  producing  e version,  or  so 
that  the  os  uteri  pressed  upon  the  sacrum  where,  by 
mere  friction,  its  surface  became  abraded,  and  profuse 
leucorrhoea  ensued.  Cases  of  this  character  I  have  seen 
not  unfrequently.  It  is,  however,  among  this  class  that 
the  instances  of  incurable  sterility  come,  and  the  reason 
given  is  to  me  a  perfectly  satisfactory  one. 

In  certain  of  these  cases  it  is  evident  that  the  sterility 
can  proceed  from  none  of  these  causes,  because  after 


TWIN    BIRTHS    STERILE.  107 

the  administration  of  internal  medicines  intended  to 
act  as  local  excitants,  conception  has  followed.  The 
effect  of  these  remedies  could  have  been  neither  the 
unlocking  of  the  fetters  which  bound  down  the  Fallo- 
pian tubes,  or  by  removing  any  of  the  interposed  fat, 
but  was  limited  in  its  action,  to  that  of  a  local  stim- 
ulus. 

The  only  method  of  accounting  for  these  cases  is  to 
suppose  a  loss  of  vitality  in  the  organs,  and  conse- 
quently a  failure  in  the  evolution  of  the  Graafian 
vesicle  in  the  ovary. 

We  are  aware  that  we  have  merely  substituted  hard 
words  as  a  description  of  some  unknown  disease  ;  but 
the  plain  fact  is,  that  without  any  perceptible  reason, 
no  ovum  is  formed  in,  or  escapes  from,  the  ovary  into 
the  uterus — and  to  no  other  condition  of  things  can  be 
ascribed  this  actual  untoward  result.  This  form  of 
sterility  will  be  again  referred  to,  under  the  corres- 
ponding head  in  the  chapter  on  Treatment. 


There  is  a  popular  belief  among  a  certain  class, 
that  where  a  male  and  female  are  born  at  a  twin  birth, 
the  female  will  be  henceforward  sterile.  It  is  probable 
that  this  belief  originated  with  the  graziers,  for  it  is 
stated  as  a  fact  that  where  a  heifer  and  bull  twins 
occur,  the  heifer  will  not  conceive.  Among  cattle 
raisers,  this  heifer  is  called  a  "free-martin,"  and  so 


108  PATHOLOGY    OF    STERILITY. 

undoubted  is  the  belief,  that  this  free-martin  is  either 
killed  as  a  calf,  or  if  raised,  is  regularly  broken  to  the 
yoke  and  worked  like  any  ox.  Many  men  of  intelli- 
gence have  made  this  statement  to  me,  and  it  may  be 
found  in  agricultural  journals. 

Among  cattle  such  may  be  the  fact,  although  I  very 
much  doubt  it,  but  after  a  careful  examination,  I  am 
convinced  that  such  is  not  the  fact  in  respect  to  the 
human  race  ;  as  I  have  known  of  numerous  instances  to 
the  contrary,  and  do  not  now  remember  ever  hearing 
one.  statement  in  corrobora,tion  of  this  opinion. 

Prof.  Simpson  of  Edinburgh,  who  has  made  con- 
siderable research  upon  this  subject,  acknowledges 
"  the  infecundity  of  free-martin  cows  to  be  a  very 
general  fact,  but  by  no  means  an  universal  one."  He 
has  also  collected  the  facts  relative  to  the  married 
history  of  123  females  born  co-twin  with  males,  112 
of  whom  had  offspring,  and  11  none,  although  married 
several  years.  "  In  other  words,  the  marriages  of  the 
females  born  under  these  circumstances  were  unproduc- 
tive in  the  proportion  of  one  to  ten." 


Sterility  may  be  divided  into  two  classes,  the  mar- 
ried female  who  has  never  had  children,  and  she  who 
has  had  one  or  more,  but  yet  who  has  been  barren  for 
many  years. 

Congenital  malformation  or  imperfection,  of  course 


PECULIARITIES    OF    THE    STERILE.  109 

pertains  exclusively  to  the  first  of  these  divisions.  It 
is  of  very  rare  occurrence,  for  in  general  it,  in  both 
classes,  arises  from  some  of  the  diseases  above  enumer- 
ated ;  but  occasionally  natural  physical  imperfection  is 
the  origin.  When  this  is  the  case,  there  is  usually 
certain  physical  peculiarities  and  mental  manifestations 
and  idiosyncracies  which  will  lead  one  to  suspect  the 
physical  deficiency. 

I  have  met  with  several  cases  of  this  character, 
where  there  was  an  absence  of  the  uterus,  or  where 
there  was  evidently  an  uterus,  but  where  there  never 
was  any  menstrual  secretion.  One  where  I  made  a  post- 
mortem of  a  lady  nearly  a  century  old,  who  had  never 
menstruated  or  borne  children,  and  where  atrophy  of 
the  ovaries  and  obliteration  of  half  the  cavity  of  the 
uterus  existed,  and  all  had  marked  peculiarities  of 
temper,  feelings,  and  tastes.  The  maid  who  had  never 
menstruated  had  suffered  from  various  maladies,  and 
was  fickle  and  changeable  in  taste  and  manners.  Both 
the  others  manifested  no  fondness  for  men's  society  ; 
one  married  for  a  home  ;  the  other  "  went  to  parties  to 
hear  the  music  and  to  get  a  good  supper  ;"  both  were 
excellent  housekeepers  ;  both  were  severe  in  their 
judgments  of  their  friends,  and  had  no  compassion  for 
"lovely  woman  stooped  to  folly."  Neither  of  these 
two  was  squeamish  in  her  actions,  and  possessed  little 
delicacy  or  the  soft  attributes  of  woman.  A  recent 
case  is  reported  by  Dr.  Baskette  {Southern  Medical  and 


110  PATHOLOGY    OF    STERILITY. 

Physical  Journal,  May  and  June  1855.)  I  merely  hint 
at  these  peculiarities,  to  draw  attention  to  them,  and 
not  with  the  design  of  giving  any  description  of  the 
cases  ;  they  having  been  reported  in  the  New  York  Med. 
Times,  and  other  journals  some  years  since. 

Tyler  Smith  says:  "In  general,  the  hair  of  the 
mons  veneris  is  short  and  curled  ;  but  in  sterile  women 
I  have  sometimes  observed  it  to  be  straight,  and  longer 
or  shorter  than  usual — this  condition  being  indicative 
of  a  feeble  development  of  the  internal  organs  of  gener- 
ation." 

The  woman  barren  from  local  disease,  whether  she 
has  ever  borne  children  or  not,  is  characterized  by 
other  symptoms,  which  are  clearly  to  be  ascribed  to 
some  disease,  viz.,  nervous  excitement  and  depression, 
gastric  irritations,  with  more  or  less  desire  for  food,  for 
unusual  articles,  even  for  indigestible  and  often  dis- 
gusting things,  hysterical  urine,  constipated  bowels, 
irregular  menstruation,  often  protracted  and  profuse, 
(occasionally  very  scanty),  leucorrhoea,  pain  in  back, 
&c.,  &c.  The  phases  of  the  symptomatic  manifesta- 
tions of  this  condition  of  things  are  equalled  only  by 
the  permutations  of  the  ten  cardinal  numbers. 

With  these  physical  and  mental  manifestations  of  a 
local,  plainly  evident  disease  —  the  patient  in  her 
frequent  paroxysms  of  nervous  excitement,  insisting 
ever  and  anon  that  she  shall  die  or  is  dying — and  the 
weary  friends  almost  wishing,   in  their   desire  for  a 


ABSENCE    OF   SEXUAL   APPETITES.  Ill 

moment's  quiet  and  forgetfulness,  that  she  would  ;  the 
sufferer  lingers  out  year  after  year,  till  some  crisis, 
with  its  sure  floodings,  either  reducing  the  sufferer  by 
exhaustion  to  an  early  grave,  or  longer  delayed, 
malignant  disease,  may  seize  the  debilitated  organ,  and 
after  a  life  of  torture  unutterable,  loathsome  and  com- 
fortless to  herself  and  her  friends,  inevitable  death 
made  more  cruel  by  delay,  seizes  its  willing  victim, 
rejoiced  to  be  once  free  from  anguish. 


According  to  my  own  views,  the  reasons  given  for 
the  want  of  fertility  in  the  previous  remarks,  embrace 
all  the  causes  that  exist,  but  there  are  a  train  of  causes 
alleged  by  other  writers,  and  especially  insisted  upon 
by  Roubaud  in  his  recent  work,  Traite  de  VImpuissance 
et  de  la  Sterilite,  Paris,  1855,  and  which  I  will  there- 
fore mention.  They  are  classed  under  the  head  of 
"  Impuissance  par  Frigiditey  Frigidity  or  want  of 
sympathy  in  the  sexual  embrace,  and  an  entire  absence 
of  sexual  appetites  and  pleasures,  from  age,  constitu- 
tion, temperament,  diseases  (the  effects  of  over  feeding 
or  drinking,  masturbation,  local  disease,  venereal 
excesses,  &c.,  &c.). 

I  am  convinced  that  but  one  question  only  is  to  be 
asked,  viz.  if  healthy  spermatozoa  are  brought  into 
contact  with  healthy  ova,  to  decide  this  question.  Frig- 
idity may  or  may  not  accompany  the  act ;  the  result  is  as 


112  ■  PATHOLOGY    OF    STERILITY. 

independent  of  sensation,   as   if  it   were    a   chemical 
transformation  that  is  going  on. 


Before  leaving  this  branch  of  my  subject,  I  will 
allude  to  two  constitutional  causes  of  sterility,  the  one 
is  mercurialization,  the  other,  constitutional  syphilis.  It 
is  alleged  that  many  persons  who  have  been  profusely 
salivated,  and  whose  constitution  still  retains  mercurial 
poison,  are  incapable  of  either  generating  or  being 
fecundated.  I  cannot  here  discuss  the  question,  but  I 
doubt  the  fact  of  a  person's  retaining  mercury  in  his 
system  for  any  long  period  of  time.  I  have  seen  many 
persons  who  had  taken  mercurials  for  various  diseases, 
and  who  complained  of  its  effects,  and  in  my  experi- 
ence, these  effects  were  attributable  solely  to  the 
original  disease  not  being  entirely  eradicated,  and  that 
a  little  more  of  the  poisonous  medicine  so  loudly 
blamed,  entirely  removed  its  supposed  effects. 

Constitutional  syphilis  is  also  supposed  to  be  a  cause 
of  infertility,  and  with  some  show  of  reason,  for  it 
unquestionably  does,  in  a  degree,  impair  and  paralyze 
the  male  semen  ;  but  in  my  opinion,  in  respect  to 
females,  it  is  more  often  a  cause  of  early  abortion,  from 
an  imperfect  development  of  the  ovum,  than  a  cause  of 
sterility,  as  it  is  difficult  to  decide  whether  the  woman 
is  ever  impregnated  or  not.  The  menses  are  retained 
a  few  days  over  the   usual   period,  there  is  finally  a 


ABORTION    MISTAKEN    FOR   BARRENNESS.  113 

some\rliat  profuse  discliarge,  accompanied  by  more  pain 
than  usual,  and  the  passage  of  what  are  considered 
clots,  but  in  them  lies  concealed  the  semi-developed 
ovum — a  condition  of  things  like  to  that  observable  in 
those  professional  females  who,  by  excessive  intercourse 
so  irritate  the  uterus,  that  it  throws  off  its  contents. 
These  females  not  noticing  any  sign  of  pregnancy, 
imagine  themselves  barren,  when  they  are  on  the 
contrary,  subject  only  to  repeated  abortions. 


8 


114  THERAPEUTICS   OF   STERILITY. 


III. 

THERAPEUTICS  OF   STERILITY. 

The  previous  chapters  having  been  devoted  to  the 
Physiology  of  Generation,  and  to  a  description  of  those 
abnormal  conditions  and  diseases,  which  in  a  greater  or 
less  degree  retard  or  entirely  interfere  with  this  pro- 
vision of  nature  for  the  continuance  of  our  species,  I 
come  naturally  to  the  third  portion  of  my  work,  viz. 
the  Treatment. 

Successful  Treatment  and  Cure  are  sometimes 
synonymous.  They  are  so  where  the  surgeon  coaptates 
the  ends  of  a  broken  bone,  and  restores  the  patient  to 
pristine  strength  and  vigor  ;  it  is  not  so  where  he  is 
compelled  to  amputate  a  diseased  portion,  and  thus 
leaves  the  sufferer  weU  in  health,  but  mutilated  and 
inefficient  in  power. 

In  the  class  of  difficulties  which  we  are  now  con- 
sidering, in  by  far  the  greater  proportion,  the  terms 
are  synonymous.  The  actual  disease  bears  small  rela- 
tion to  the  misery  it  entails,  and  in  the  vast  majority 
of  females  it  may  be  predicated  that  entire  relief  can 
be  afforded.     But  two  requisites  may  then  be  required 


PERIOD    OF    POSSIBLE    PREGNANCY.  115 

in  order  to  subsequent  fecundation,  under  proper 
influences.  1st. — That  the  female  shall  have  attained 
a  sufficient  maturity,  and  yet  may  not  have  passed  that 
term,  after  which  conception  is  unattainable. 

(This  period  can  scarcely  be  measured  by  any  parti- 
cular number  of  years,  inasmuch  as  its  limit  is  the 
period  during  which  menstruation  occurs  (sometimes, 
as  before  noted,  unmarked  by  any  external  manifesta- 
tions. In  different  climates  this  period  varies.  Proba- 
bly 14  is  the  average  age  of  first  menstruation  in  this 
country,  .and  39  that  of  its  complete  cessation.  There 
are  strange  exceptions  however.  A  few  years  since  I 
had  a  patient  aged  21,  the  mother  of  five  children  at 
single  full-timed  births.  I  know  another,  married  at 
13i  years  of  age,  to  a  boy  17i,  and  a  mother  at  14 
and  a  few  months,  and  that  too,  with  no  previous 
signs  of  menstruation,  except  the  blood  of  the  nuptial 
night. 

A  more  remarkable  instance  was  the  precocity  of  a 
little  girl,  Phoebe  Ann  Baker,  exhibited  at  Barnum's 
first  baby-show.  I  saw  her  at  my  office,  July  27th, 
1855,  and  took  the  following  notes.  "  Phoebe  Ann 
Baker  was  born  at  Sing  Sing,  New  York,  January  19th 
1851.  Her  mother  has  one  other  child,  a  boy  of  7 
years.  Parents  both  American.  At  birth  she  weighed 
14  pounds,  and  has  always  since  been  large.  Dr.  Hoff- 
man being  the  attending  physician.  When  10  months 
old,    a   bloody   flow    was    noticed   from    the    puden- 


116  THERAPEUTICS    OF    STERILITY. 

dum,  and  this  has  continued  periodically  ever  since, 
until  the  present  date,  without  at  any  time  going  longer 
than  six  weeks  (and  when  thus  protracted  showing 
signs  of  physical  disturbance)  without  its  appearing. 
About  the  time  this  flow  commenced,  a  marked  enlarge- 
ment of  her  breasts  was  noticed,  and  they  very  soon 
attained  to  their  present  size,  being  now  equal  to 
those  of  most  girls  of  16  years,  of  perfect  shape, 
having  a  well-formed,  but  not  very  protuberant 
nipple,  and  an  areola  of  a  light  brown  color.  She 
weighs  64  pounds,  and  is  of  remarkable  size  for  her 
age,  fully  developed  in  form,  and  of  a  maturity  of 
appearance  most  noticeable.  The  hips  are  full,  the 
limbs  rounded,  and  her  form  would  indicate  that  she 
had  attained  maturity  and  puberty."  When  I  saw  her 
as  above  described,  this  flow  had  been  retarded  for 
some  two  weeks  longer  than  usual,  and  the  mother 
seriously  supposed  her  pregnant,  as  she  had  discovered 
a  man  (for  which  sex  she  evinced  great  fondness),  in  an 
improper  situation  respecting  her,  and  she  had  arrested 
him,  and  he  lay  several  days  in  prison  on  this  charge. 
The  flow,  however,  soon  reappeared.) 

2nd. — That  no  disorganizations  have  been  effected  in 
the  progress  or  cure  of  the  disease,  which  may  preclude 
the  possibility  of  a  fruitful  intercourse. 


In  expressing  the  results  of  my  experience  in  the 


REMOVAL    OF    THE    HYMEN.  117 

treatment  and  cure  of  Sterility,  I  shall  pursue  the  same 
plan  adopted  in  the  chapter  on  the  Pathology  of  the 
disease,  and  commencing  with  the  external  vaginal 
opening,  shall  in  turn  take  up  each  portion  of  the 
genital  apparatus  implicated,  and  follow  it  out,  until 
the  investigation  shall  ultimate  in  the  ovary  ;  and  even 
farther,  where  no  recognized  pathological  condition  is 
present,  to  offer  an  answer  to  the  query,  why  concep- 
tion does  not  take  place. 

I  have  said  that  the  semen  of  the  male,  or  its  fructi- 
fying principle,  the  spermatic  filament  or  vesicle,  may 
fail  to  enter  into  the  vagina,  or  the  uterus,  or  to  come 
into  contact  with  the  uterus. 

First. — From  malformation  of  the  vagina  ;  and  an 
imperforate  hymen  is  among  the  most  common  causes, 
and  is  easily  recognized.  Theoretically,  the  most 
approved  manner  of  treatment  would  be  to  divide  it 
by  a  quadrangular  incision,  but  practically,  an  opening 
made  with  a  bistoury,  a-n  ordinary  scalpel,  or  a  lancet, 
in  any  direction,  of  sufficient  size  to  admit  the  finger, 
will  answer  the  purpose. 

Brown  says  that  the  crucial  or  stellate  incision 
ordinarily  used,  may  be  used  upon  the  very  young. 
This  leaves  the  divided  portion  of  the  hymen  to 
retract,  and  remain  on  each  side  of  the  vaginal  orifice, 
and  will  create  no  irritation  of  consequence;  but  when 
the  woman  has  passed  her  25th  or  30th  year,  the 
divided  portions  do  not  then  shrivel  or  pucker  up,  and 


118  THERAPEUTICS    OF    STERILITY. 

vaginitis  is  apt  to  occur  from  the  friction  of  these 
surfaces  together,  which  may  spread  even  to  the  peri- 
toneum He  therefore  recommends  that  the  hymen  be 
removed  entire  by  a  circular  incision  at  the  point  of 
junction  with  the  labia. 

If  the  organ  be  imperforate,  the  discharge  of  retained 
menses  will  be  sufficient  evidence  that  the  work  has 
been  accomplished  properly,  and  the  incision  has  been 
made  in  a  right  direction.  Should  an  opening  exist  in 
a  firm  and  unyielding  membrane,  so  strong  as  to  have 
resisted  the  marital  impulses,  a  probe-pointed  bistoury 
will  be  the  most  available  instrument  to  effect  this 
purpose.  Little  topical  treatment  will  be  found 
necessary,  unless  the  divided  portions  have  a  tendency 
to  fall  together,  and  there  be  danger  of  reunion,  then 
a  small  piece  of  lint  being  placed  within,  cicatrization 
of  the  cut  edges  will  soon  take  place,  and  it  will  be 
found  that  little  impediment  will  exist  to  congress. 
.Even  then,  gentleness  and  inunctions  with  some  bland 
oil  will  be  desirable,  and  ought  not  to  be  overlooked 
for  its  simplicity. 

The  cutting  of  this  membrane  is  so  entirely  free 
from  pain,  bleeding,  or  any  similar  cause  of  fear,  that 
any  attempts  at  dilatation  will  be  scarcely  worth  the 
delay  consequent  upon  this  method  of  relief.  If,  how- 
ever, the  idea  of  the  knife  is  insurmountable,  dilatation 
may  easily  be  effected  in  the  manner  I  shall  shortly 
recount  in   cases   of  stricture   of  the    vagina,   or   as 


STRICTURE    OF    THE    VAGINA.  119 

usually  adopted  in  similar  strictures  of  the  uretlira, 
rectum,  &c. 


The  mechanical  impediment  of  a  contraction  of  the 
vagina,  impeding  and  often  preventing  the  perfect 
entrance  of  the  male  organ  sufficiently  to  enable  the 
semen  to  be  ejected  up  to  the  os  uteri  is  to  be  over- 
come by  purely  mechanical  means.  If  the  passage  be 
a  simple  contraction  without  cicatrix  or  loss  of  sub- 
stance, a  bougie  may  be  passed  through  the  opening, 
and  the  passage  may  be  thus  gradually  dilated,  by 
increasing  the  size  of  the  instruments,  until  it  be  suffi- 
ciently enlarged  to  admit  of  a  piece  of  prepared 
sponge.  Cones  of  this  sponge  should  then  be  daily 
introduced,  increasing  their  size  as  rapidly  as  possible, 
until  the  stricture  be  sufficiently  overcome. 

The  most  economical  and  convenient  material  for 
making  the  graduated  bougies  above  referred  to,  is 
gutta  percha,  which,  softened  in  hot  water,  will  take 
any  shape  that  may  be  desired,  and  may  be  changed  as 
often  as  necessary. 

Strictures  which  are  the  result  of  injuries,  are  more 
formidable,  but  still  will  admit  of  relief.  Local 
injuries  from  sharp  instruments,  from  falls  upon  stakes, 
producing  lacerations  and  bruises,  are  often  followed  by 
great  inflammatory  action,  resulting  in  sloughs,  adhe- 
sions, &c.     These  separate  cases,  having  peculiar  causes 


120  THERAPEUTICS    OF    STERILITY. 

and  conditions,  can  come  under  no  general  description. 
Each  case  must  be  treated  according  to  its  character, 
by  dilatation  with  bougies,  sponge  tents,  and  by  dividing 
the  contracted  cicatrices  with  the  knife.  In  this  class, 
which  are  the  direct  result  of  local  injury,  the  astute 
practitioner  will  have  little  difficulty  in  applying  the 
proper  operation  to  the  case,  and  effecting  ultimately  a 
beneficial  result. 

I  have  seen  one  instance  where  the  entrance  of  the 
penis  was  prevented  by  a  contracting  of  the  passage, 
produced  by  a  rachitic  condition  of  the  pelvic  bones, 
so  diminishing  the  passage,  or  rather  rendering  it  so 
tortuous,  that  the  erect  penis  could  not  follow  its 
windings. 

Pregnancy  in  such  a  case  could  only  terminate  with 
the  greatest  hazard  to  the  mother,  and  it  is  fortunate 
that  conception  was  thus  rendered  difficult,  if  not 
impossible.  As  the  difficulty  arose  from  a  distortion 
of  the  ostia,  and  not  from  a  bony  tumor,  any  beneficial 
interference  would  have  been  impossible. 

Extreme  sensitiveness  of  the  vagina  not  unfrequently 
produces  so  great  suffering,  that  the  female  rarely 
admits  the  embraces  of  her  husband,  and  then  with 
such  shrinking,  as  scarcely  to  allow  the  penis  to  enter 
into  the  vagina.  Such  a  condition  is  generally  tem- 
porary, and  is  the  effect  of  a  slight  inflammatory  action 
either  of  a  benign  or  of  a  gonorrhoeal  character. 
When   chronic,   it  is  generally  a  consequence  of   the 


LOCAL    ANESTHETICS. 


121 


acrid  discharges  connected  with  disease  of  .the  os  uteri, 
to  be  hereafter  spoken  of 

Occasionally  it  has  been  recognized  as  proceeding 
from  small  tumors,  exquisitely  sensitive,  which  are 
located  within  or  around  the  mouth  of  the  urethra.  It 
is  sometimes  necessary  to  divide  the  urethra,  and  to 
carefully  dissect  these  tumors  away  from  their  sites, 
the  most  powerful  caustics  failing  to  give  any  relief. 
In  other  instances,  where  there  is  no  local. cause  per- 
ceptible, relief  has  been  found  by  the  application  of 
narcotics,  very  effectual  among  which  is  the  aconite 
tincture.  Marked  benefit  is  also  to  be  perceived  from 
the  local  application  of  the  vapor  of  chloroform. 

I  will  here  allude  to  the  very  marked  benefit  some- 
times observed  from  the   injection  of  the  vapor   of 


Fio.  30. 


chloroform  in  various  uterine  affections  productive  of 
pain,  as  dysmenorrhoea,  rheumatic,  neuralgic  and  other 


122  THERAPEUTICS   OF    STERILITY. 

troubles.  Mr.  Tiemann  has  constructed  an  instrument 
(Fig  30),  peculiarly  adapted  for  this  purpose. 

It  consists  of  a  tube  in  which  is  placed  a  sponge 
saturated  with  cliloroform.  An  india  rubber  hollow 
ball  at  one  extremity,  upon  pressure,  draws  air  through 
a  valved  opening,  and  forces  it,  saturated  with  chloro- 
form vapor,  through  the  pointed  extremity  ujion  any 
desired  locality.  By  placing  one  end  of  an  elastic  tube 
upon  the  valved  opening,  and  the  other  being  con- 
nected with  a  vessel  containing  chloroform,  pure  vapor 
may  be  injected. 

Lately  carbonic  acid  gas  has  been  recommended  by 
Prof.  Simpson  as  a  local  anaesthetic,  and  which  seems, 
from  an  imperfect  experience,  to  be  useful  in  some 
cases. 

Ligatures  are  useless  in  the  treatment  of  these  rare 
affections,  as  they  cannot  be  made  to  embrace  the 
whole  diseased  portion,  and  in  dissecting  them  away 
with  the  knife  or  sharp  scissors,  the  mucous  membrane 
to  which  they  are  attached,  should  also  be  removed,  and 
the  spot  should  afterwards  be  seared  by  nitric  acid, 
applied  upon  a  pointed  stick,  the  circumjacent  parts 
being  surrounded  by  a  piece  of  lint  soaked  in  a  strong 
solution  of  nitrate  of  potash.  Mr.  Brigham  of  the 
Lock  Hospital,  Manchester,  advises  the  actual  cautery. 

Tumors  in  the  vagina,  in  the  recto-vaginal  septum, 
the  vesico-vaginal  space,  calculi,  and  various  diseases 
affecting  the  bladder  and  rectum,  may  all  render  coition 


VERSIONS  OF  THE  UTERUS.  123 

impracticable  : — their  consideration  does  not  demand 
attention  in  this  connection. 

The  difficulties  which  prevent  the  semen  from  enter- 
ing the  uterine  cavity,  as  already  enumerated,  are 
numerous. 

Where  there  is  chronic  eversion  of  the  uterus,  preg- 
nancy is  impossible,  for  even  if  the  uterus  be  restored 
to  its  natural  situation,  the  character  of  the  parts  is 
so  changed,  that  all  hopes  of  future  child-birth  must  be 
precluded. 

Ante  and  retro-versions  are  among  the  most  trouble- 
some forms  of  uterine  disease,  and,  too,  are  far  more 
common  than  has  been  supposed.  When  not  of  severe 
character,  and  when  unaccompanied  by  other  uterine 
disease,  pregnancy,  although  of  rare  occurrence,  is  not 
impossible.  I  have  witnessed  three  cases,  in  which 
abortion  took  place,  in  consequence  of  slight  extra 
e5i:ertion,  about  the  third  month. 

When  recent,  the  displacement  may  be  easily  cor- 
rected ;  mere  recumbency  upon  the  back  will  tempor- 
arily restore  many  cases  of  ante-version,  which  will 
return  again  after  any  considerable  exercise. 

The  uterine  sound  passed  into  the  os  uteri,  with 
pressure  upon  the  fundus  uteri  by  the  finger  through 
the  rectum,  will  often  restore  a  recent  case  of  retro- ver- 
sion. When  this  displacement  is  chronic,  the  cure  is 
also  chronic,  frequent  introduction  of  the  sound  into 
the  neck  of  the  os  uteri,  allowing  it  to  remain  for  a 


124 


THERAPEUTICS    OF    STERILITY. 


considerable  period  daily  in  the  cavity,  until  the 
internal  surface  has  became  accustomed  to  a  foreign 
body,  and  then  introducing  Simpson's  internal  uterine 
supporter  (Fig.   31),   for  an  hour  at  first;  gradually 


Fig.  31. 


increasing  the  time,  until  it  can  be  borne  constantly,  I 
have  known  followed  by  great  benefit,  and  finally 
effecting  a  radical  cure.  Great  caution  should  be  used, 
or  inflammation  will  be  excited,  which  will  sometimes 


Simpson's  pessary.  125 

proceed  to  a  dangerous  extent.  So  warm  and  diverse 
have  been  the  statements  made  respecting  this  instru- 
ment, that  I  consider  it  my  duty  to  speak  commenda- 
torily  of  it  in  certain  conditions,  and  in  certain  subjects. 
I  assuredly,  however,  should  not  venture  to  apply  it  in 
cases  where  there  was  great  uterine  sensibility,  at  least 
until,  by  a  course  of  training,  the  organ  had  been 
rendered  less  sensitive  and  impressionable. 

One  of  the  great  objections  urged  against  this  instru- 
ment, is  its  rigidity,  that  it  remains  in  a  fixed  position, 
irrespective  of  any  change  in  the  position  of  the  body ; 
that  therefore  it  is  frequently  painful  from  pressure  ; 
that  it  is  liable  to  effect  immense  injury  to  the  wearer, 
should  any  accident  or  shock  happen  to  her.  To 
obviate  these  objections,  Mr.  Tiemann  has  modified  the 
instrument  by  placing  a  spiral,  gutta-percha  covered 
spring  at  the  union  of  the  parts  marked  h  and  c,  in 
Fig.  31,  so  that  free  motion  is  permitted  to  b,  the  stem, 
which  is  to  enter  the  os.  Another  beneficial  result  is 
that,  while  the  tendency  of  this  spring  is  to  keep  b 
perpendicular,  and  thus  to  raise  the  uterus  to  its 
normal  position,  yet  this  is  not  forcibly  and  entirely 
accomplished  immediately  upon  its  introduction,  but 
is,  if  the  resistance  be  great,  to  be  gradually  effected 
by  the  constant  action  of  the  spring.  The  probability 
of  injury  from  accident  is  also  much  lessened.  This 
improvement  is  shown  in  Fig.  32. 

Ante-version  has  occurred,  and  is  often  continued 


126 


THERAPEUTICS    OF    STERILITY. 


from  irregularities  of   the  bowels,   the  rectum  being 
allowed  to  remain  filled  with  an  immense  accumulation. 


Fio.  32. 


In  many  cases,  merely  attending  to  this  organ  alone, 
is  sufficient  to  restore  the  uterus  to  its  natural  condi- 
tion. Certainly,  no  other  treatment  would  be  justifi- 
able, until  ■  the  regularity  and  effectiveness  of  the 
uterine  discharges  are  fully  established. 

"An  intestinal  canal  loaded  with  large  fsecal  accu- 
mulations, not  only  obstructs  the  returning  circulation 
from  the  pelvic  viscera;  as  is  so  commonly  seen  by  its 
effects  in  producing  an  hcemorrhoidal  habit,  but  by 
pushing  down  the  uterus-  into  the  pelvis  lower  than 
is  natural,  for  its  venous  circulation  becomes  also 
impeded,  and  considerable  engorgement  of  the  organ  is 
produced."  *  *  * 


TREATMENT    OF   VERSIONS.  127 

"Until  this  deposit  is  removed,  we  can  scarcely  be 
said  to  have  ascertained  the  real  extent  of  the  local 
affection." — Dr.  E.  Righy. 

Retro-version  has  been  caused  by  active  exercise,  or 
merely  passive  exercise  in  riding  or  the  like,  with  the 
bladder  over-distended  with  fluid.  Such  an  occurrence, 
however,  may  be  a  cause,  but  the  cause  is  not  persis- 
tent, and  its  continuance  is  owing  to  other  reasons. 

Curious  enough,  the  very  producers  of  flexions  and 
versions  of  the  womb  which  I  have  described,  have  been 
recommended  as  curative  agents.  M.  Hugier  advises, 
in  cases  of  ante-version,  that  the  urine  be  retained  as 
long  as  possible,  and  rarely,  if  ever,  to  be  entirely 
evacuated,  that  by  the  bulk  of  the  distended  bladder, 
the  obliquity  of  tlie  uterus  may  be  rectified.  In  the 
same  manner,  also,  he  advises  the  faecal  matter  to  be 
retained  in  the  rectum,  to  restore  the  retroverted 
womb  to  its  natural  situation.  I  have  no  experience  in 
this  method  of  cure. 


Tumors  forming  mechanical  obstructions  to  concep- 
tion, are  principally  polypi.  When  lying  within,  and 
low  down  in  the  vagina,  they  are  usually  of  some  size, 
and  it  is  from  their  irritation  and  the  acrid  character 
of  their  discharges,  that  they  can  have  much  influence 
upon  the  generative  functions.  Their  treatment  must 
depend  upon  their  variety.     If  possessing  a  distinctive 


128  THERAPEUTICS    OF    STERILITY. 

neck,  and  small  in  diameter,  it  can  be  easily  surrounded 
by  a  ligature,  and  strangulated  ;  if  larger,  a  doubly- 
armed  needle  may  be  passed  through  the  centre,  and 
by  tying  each  half  separately,  the  circulation  will  be 
more  effectually  cut  off,  and  the  tumor  thus  destroyed. 

According  to  my  observation,  the  best  form  of  liga- 
ture is  wire  of  pure  silver,  which  may  easily  be  passed 
around  and  through  the  tumor,  and  twisted.  It 
requires  no  knot,  remaining  firm  and  fast  ;  it  may  be 
tightened  more  or  less,  as  desired,  and  ac  often  as 
desired,  with  little  difficulty  ;  is  strong,  cleanly  and 
efficient.  In  most  cases  it  will  require  no  instruments, 
adjuncts,  or  accessories.  When  wire  is  not  used,  on 
the  contrary,  if  high  up,  or  wherever  the  tumor  be 
situated,  if  it  be  requisite  to  tighten  the  ligature  on 
succeding  days,  a  canula  will  be  absolutely  necessary. 

One  of  the  easiest  means  of  removing  these  intra- 
vaginal,  or  intra-uterine  polypi,  is  by  means  of  a  little 
polypus  forceps  (Fig.  33),  invented  by  M.  Luer  of 
Paris  ;  the  first  of  which  I  saw,  was  presented  to  me  by 
the  inventor  and  maker.  The  museau  de  tanche  ter- 
mination enables  one  not  only  to  seize  the  tumor  by  a 
broad  surface,  but  its  interior  grooved  bite  prevents 
any  slipping.  It  will  be  found  very  effective  in 
drawing  down  the  tumor,  when  any  operation  is  to 
be  performed  upon  it.  The  rachet  upon  the  handle 
will  hold  the  instrument  at  any  fixed  point. 

In  many  cases  where  it  might  be  found  difficult  to 


FL.U'K    V 


n. 


^M^: 


^.c^^ 


) 


T.  Suiclaivs  wiuuiui.!  i:Ji  .1 


UNNOTICED    POLYPI. 


129 


pass  a  ligature  around  the  pedicle  of  the  tumor,  the 
pedicle  itself  may  be   seized   by   these   forceps,    and 


Fig.  33. 


,?«"ilk 


conipressed,  and  there  retained  by  means  of  the  rachet, 
and  if  desirable,  they  may  be  left  hanging  loosely,  or 
supported  by  an  attachment  to  a  girdle,  and  worn 
until  the  tumor  thus  strangulated,  falls  off,  a  result 
easily  obtained  by  the  facility  of  increasing  the  pressure 
by  the  rachet-handle.  These  instruments  are  made  of 
various  sizes,  and  can  thus  be  adapted  to  tumors  of 
diverse  magnitudes. 

The  minute  polypi  which  spring  from  the  cervix 
uteri,  seem  originally  to  have  been  but  profuse  granu- 
lations, which  have  become  semi-organized.  Bathed  in 
a  muoo-purulent  secretion,  often  enveloped  in  a  clot  of 
blood,  they  are  very  apt  to  be  unnoticed.  In  all  cases 
where  a  speculum  examination  is  made,  I  am  in  the 
habit  of  carefully  and  thoroughly  wiping  the  os  uteri 
with  cotton  or  lint,  which  will  invariably  expose  the 
polypus,  if  without  the  cervix.  But  even  when  plainly 
before  the  eye,  it  will  often  be  unnoticed  by  the  care- 

9 


130  THERAPEUTICS    OF    STERILITY. 

less  examiner,  from  its  diminutive  size,  and  its  resem- 
blance in  color  and  general  appearance  to  the  diseased 
surface  around,  with  which  it  is  in  immediate  contact. 

The  most  effectual  and  best  means  for  their  removal 
is  at  the  same  time  the  speediest.  They  should  be 
seized  with  the  forceps,  twisted  and  thus  torn  off.  But 
little  haemorrhage  results,  and  no  pain  is  perceptible. 
The  abraded  surface  around  and  the  site  of  the  pedicle 
should  then  be  touched  with  a  stick  of  pure  Nitras 
Argenti,  which  will  effectually  restrain  any  further 
bleeding.  This  application  should  be  continued  weekly, 
till  all  disease  is  entirely  healed. 

Occasionally  there  is  a  large  fungous  growth  within 
the  cerv'x  which  may  be  the  ovulae  nabothii  in  large 
quantities,  or  a  profusion  of  vesicular  polypi.  Recamier 
invented  a  curette  or  scoop,  with  which  he  scraped  out 
the  OS  uteri,  thus  forcibly  and  roughly  removing  them. 
At  present,  this  plan  has  few  followers,  and  either  the 
lunar  caustic,  or  the  acid  nitrate  of  mercury  is  pre- 
ferred to  be  applied,  and  thus  more  effectually  to 
destroy  them.  In  such  a  diseased  condition  of  the 
cavity,  the  irritation  from  Simpson's  intra-uterine 
pessary,  is  sometimes  found  to  be  serviceable. 

When  polypi  are  felt  within  a  patulous  os  uteri,  or 
when  their  presence  is  suspected  from  the  haemorrhagic 
discharges,  the  flaccid  lips  of  the  os  uteri  may  be 
gently  pressed  asunder  by  means  of  the  speculum  os 
uteri  (Fig.  28),  or  which  is  nearly  as  useful,  by  passing 


TORSION    OF   POLYPI.  131 

the  closed  points  of  the  vaginal  forceps  within  the  os, 
and  then  separating  the  handles,  thus  parting  the  lips, 
so  that  the  eye  may  explore  the  cavity  to  some  half- 
inch,  or  inch  and  a  half. 

If  a  polypus  is  thus  discovered,  the  treatment  should 
not  differ  from  that  already  prescribed.  More  care, 
however,  should  be  used  when  in  this  locality — from 
the  difficulty  of  controlling  any  haemorrhage  that  may 
arise — that  no  forcible  traction  or  direct  severance  of 
the  attachments  of  the  polypus  be  made,  but  that 
gentle  and  careful  torsion  may  remove  it,  and  thereby 
the  more  surely  prevent  any  bleeding. 

Occasionally  these  polypi  originate  from  the  interior 
of  the  uterus,  with  the  pedicle  attached  either  to  the 
fundus  or  lower  down  upon  its  interior  surface.  .  Often 
growing  to  an  immense  size,  and  productive  of  great 
danger  when  co-existing  with  a  foetus  and  subsequent 
labor,  they  are  not  only  extremely  prejudicial  to 
health,  but  fortunately  are  usually  preventives  of 
pregnancy. 

Great  care  is  necessary  in  the  treatment  of  these 
cases,  the  manner  of  which  is  greatly  modified  by 
the  circumstances  of  the  case,  the  condition  of  the 
patient,  the  hsemorrhagic  or  malignant  character  of  the 
tumor,  &c.  Numerous  interesting  cases  of  this  de- 
scription are  found  in  the  medical  journals  and  sur- 
gical treatises,  and  especially  several  remarkable 
cases  reported,  but  not  yet  published,   as  treated  by 


I 


132  THERAPEUTICS   OF    STERILITY. 

Professor  B.  Fordyce  Barker,  and  ^^ Sixteen  Cases  of 
Intra-TJterine  Polypi, ^^  by  Dr.  Walter  Channing,  of 
Boston,  are  worthy  the  attention  of  the  student  of 
these  peculiar  affections.  Dr.  Montgomery's  mono- 
graph in  the  Dublin  Journal  of  Medicine,  August  1846, 
is  full  upon  this  subject. 

The  only  essential  difference  in  the  treatment  of  this 
form  of  the  affection,  arises  solely  from  its  location 
being  out  of  easy  access.  This  is  to  be  obviated  by 
dilating  the  os  uteri,  so  that  manipulation  may  be 
effected  within  the  cavity,  or  by  the  administration  of 
ergot,  until  the  uterine  contractions  shall  so  far  expel 
the  tumor  from  its  cavity,  that  it  may  be  seized  and 
operated  upon  as  deemed  expedient. 

Of  late,  less  fears  seem  to  be  expressed  respecting  the 
bleeding  from  polypi.  Dupuytren  is  reported  to  have 
had  haemorrhage  in  two  cases  only,  in  two  hundred 
operations.  In  view  of  this  fact,  and  in  conjunction 
with-  the  well-known  injurious  effects  of  allowing  the 
putrescent  mass  to  remain  in  the  vagina,  it  is  urged 
with  much  seeming  force,  that  excision  is  proper  in 
all  cases  ;  some  advising  that  the  ligature  should  be 
first  applied,  and  the  mass  dissevered  below;  and  others 
recommending  amputation,  and  the  actual  cautery  to 
be  applied  to  the  surface  of  the  wound.  An  ingenious 
method  of  performing  this  operation  is  to  surround  the 
neck  of  the  polypus  with  the  two  insulated  wires  of  a 
galvanic  battery,  which,  on  setting  up  the  action  of  the 


•■^H*^' 


ECRASEUR. 


133 


Fia.  34. 


134  THERAPEUTICS    OF    STERILITY. 

voltaic  current,  become  red  hot,  cut  through  and  sear 
at  the  same  time. — {Middeldorpf^  Boston  Med.  §-  Surg. 
Journal.) 

This  method  sears  the  edges  of  the  wound,  and  thie 
haemorrhage  usually  accompanying  the  removal  of 
these  tumors  is  thus  prevented.  In  hospital  practice 
this  plan  may  be  feasible,  but  setting  aside  the  trouble 
of  transporting  the  large  battery  required  for  pro- 
ducing the  white  heat  in  the  wires,  the  formidable 
appearance  of  so  extensive  an  apparatus  would  form 
a  serious  objection  among  private  patients  of  nervous 
susceptibilities. 

M.  Chassaignac,  the  distinguished  surgeon  of  the 
H6pital  la  Ribosibre,  Paris,  has  recently  invented  an 
instrument  peculiarly  appropriate  for  effecting  the 
removal  of  these  polypi  of  large  sii^e.  The  ^craseur  is 
"the  name  given  to  this  invention,  shown  in  Fig.  34, 
because  it  breaks  the  parts,  instead  of  cutting  them 
asunder.  The  principle  upon  which  the  operation  is 
performed  is  the  well-known  effect  of  torsion  in 
restraining  haemorrhage,  as  exemplified  in  all  crushed 
wounds.  K  is  a  blunt-edged  chain,  or  metallic  liga- 
ture, which  passes  through  C,  a  canula,  GG  are  the 
handles,  by  moving  which,  the  chain  is  tightened. 
BB  are  two  rachets,  holding  the  chain  as  tightened. 

In  Figs  35  and  36  we  have  representations  of 
enlarged  polypi  of  the  uterus,  and  both  in  process  of 
operation  for  their  removal.  In  Fig.  35,  the  polypus, 
D,  is  of  small  size.     A,  represents  the  rectum  ;  C,  the 


REMOVAL   OP   POLYPUS.  135 

uterus  ;  B,  the  bladder  ;  F,  shows  a  curved  instrument 
in  E,  the  vagina,  with  the  chain  around  the  pedicle  of 

Fio.  86. 


the  polypus,  just  where  it  emerges  from  the  os  uteri, 
and  in  its  natural  position. 

In  Fig.  36,  the  polypus,  A,  is  of  larger  size,  so  as  to 
prevent  successful  operation  within  the  cavity  of  the 
vagina.  By  means  of  forceps  it  is  drawn  and  exposed  to 
view,  the  ^craseur,  D,  is  applied,  and  almost  instantane- 
ously, it  is  separated  from  its  attachment,  the  uterus 
returns  to  its  normal  situation,  and  no  haemorrhage 
accompanies  or  follows  the  crushing. 

It  is  proper  here  to  state  that  internal  or  constitu- 


136 


THERAPEUTICS   OP   STERILITY. 


tional  treatment  is  rarely,  if  ever,  of  any  advantage  in 
these  forms  of  polypi ;  the  connection  with  the  system 


being  of  such  a  nature,  that  mercurials,  iodine,  or 
arsenical  preparations,  exert  no  apparent  influence 
upon  the  tumor,  while  their  administration  adds  a 
depraved  and  cachetic  condition  to  the  already  worn 
and  debilitated  general  system.     The  physical  exhaus- 


HYDATIDS  AND  ULCERATIONS.  137 

tion  should  not,  on  the  other  hand,  be  neglected,  but  by 
the  proper  use  of  chalybeate?,  tonics,  and  nourishing 
food,  the  drain  upon  the  system  should  be  met,  and 
the  physical  energies  supported.  Astringent  and  anti- 
putrescent  lotions  should  counteract  the  local  irritations. 
Should  hydatids  be  recognized  as  present,  the  dis- 
eased mass  should  be  broken  up  by  the  use  of  the 
sound,  the  uterus  excited  to  action  by  the  administra- 
tion of  ergot,  by  dilating  the  os  uteri  with  the  finger, 
or  in  such  other  manner  as  may  be  necessary  to  cause 
it  to  expel  these  unnatural  contents. 


Ulcerations  are  a  very  general,  and  most  frequently 
unperceived,  or  even  if  discovered,  unrecognized  cause 
of  sterility.  In  a  previous  chapter,  this  fact  has  been 
already  stated,  with  sufficient  minuteness.  The  appar- 
ent slightness  of  the  cause  is  scarcely  surpassed  by  the 
simplicity  of  its  treatment. 

With  the  speculum  the  diseased  portion  is  plainly 
seen,  as  already  described.  This  should  be  carefully 
wiped  with  a  pledget  of  lint  or  cotton  wool,  that  the 
whole  surface  be  plainly  exposed.  In  those  who  have 
never  been  impregnated,  i.e.,  where  no  injury  could 
have  been  done  to  the  os  or  cervix  during  any  abor- 
tion, miscarriage,  or  labor  at  the  full  time,  rarely  is 
any  fissure  discovered,  but  a  more  or  less  extensive 
abrasion,  or  ulceration. 


138  THERAPEUTICS    OF    STERILITY. 

There  is  frequently  much  difiBculty  found  in  exposing 
the  OS  to  view,  owing  to  various  causes.  One  most 
annoying,  is  slight  ante-version  of  the  uterus,  which 
brings  the  cervix  into  the  cavity  of  the  sacrum  and 
the  OS,  entirely  out  of  the  reach  of  the  eye,  and  often 
almost  of  the  finger.  A  new  speculum,  of  French 
origin,  is  now  manufactured  by  Mr.  Tiemann  (Fig.  37), 
the  end  of  which  is  so  shaped,  as  to  catch  the  os  in  its 

Fia.  37. 


raised  edge,  and  by  slightly  withdrawing  the  instru- 
ment, to  bring  the  retained  neck  into  view.  The 
utility  of  this  modification  will  be  generally  conceded 
by  those  engaged  in  treating  uterine  difficulties. 

In  the  majority  of  cases,  all  that  will  be  necessary 
to  effect  a  perfect  cure,  is  to  touch  this  diseased  surface 
with  Nitras  Argenti  Purum.  As  the  disease  almost 
invariably,  where  of  sufficient  magnitude  as  to  be  the 
cause  of  sterility,  is  not  confined  to  the  visible  portion, 
but  is  continued  up  the  canal  of  the  cervix,  the  caustic 
should  be  passed  freely  into  this  passage,  to  the  extent 
of  an  inch  or  thereabouts — and  this  treatment  should 
be  repeated  as  often  as  the  destroyed  portion  is  cast 


LOCAL  TREATMENT  OF  ULCERATIONS.       139 

ojff,  viz.,  in  from  five  to  seven  days.  During  the 
interim,  the  vagina  should  be  carefully  bathed  by  a 
profuse  injection  of  water,  of  such  a  cool  temperature 
as  shall  be  most  agreeable.  After  the  vagina  is  thus 
thoroughly  cleansed,  I  am  in  the  habit  of  prescribing  a 
wash  of  a  decoction  of  the  Corticis  Querci  Albae,  f i,  in  a 
quart  Of  water,  to  which,  when  strained,  is  added  suffi- 
cient alum  to  saturate  it.  This  has  the  double  purpose 
of  slightly  stimulating  the  diseased  portion,  and  by  its 
astringency,  contracting  the  lax  parietes  of  the  vagina, 
so  that  it  may  the  more  easily  hold  up  the  hyper- 
trophied,  and  unusually  heavy  uterus.  If  there  be  any 
vaginal  leucorrhoea  accompanying,  I  have  found  most 
marked  benefit,  as  well  as  in  cases  of  simple  vaginal 
flux,  from  the  following  : 

9.  Ferrocyanuret,  Potass,         3iT» 
Aquffi  Ginnamoni  |  iL 

M.  terendo. 
Same  gtts.  xzz.  ter  in  die. 

Other  and  more  powerful  caustics,  such  as  the  Acid 
Nitricum  Purum  ;  Hydrarg.  Acid.  Nit.  ;  Potassae  cum 
Calce  ;  Potassae  Fusae,  &c.,  I  have  found  to  be  far 
more  unmanageable,  more  dangerous,  often  productive 
of  unpleasant  results,  and  never  having  any  superiority 
over  the  simple  Nit.  Argentum.  The  heroic  treatment 
by  the  actual  cautery,  is,  I  think,  called  for  by  no  con- 
dition of  things.     It  is  as  unscientific  as  it  is  revolting. 


1 


140  THERAPEUTICS    OF    STERILITY. 

In  using  these  astringent  internal  injections,  care 
should  be  taken  in  the  time  of  their  application,  for  the 
remarks  made  in  previous  portions  of  this  volume  will 
show,  that  the  chemical  character  of  these  local  appli- 
cations will  destroy  the  spermatozoa  ;  or  even  if  simply 
mucilaginous  or  pure  water  injections  be  used,  these 
will  destroy  in  very  many  instances,  the  hope  of 
offspring,  by  the  mechanical  washing  away  of  the 
spermatic  flmd.  The  time  of  using  all  injections,  if  of 
a  chemical  character,  should  not  too  closely  precede 
copulation,  neither  if  composed  merely  of  pure  water, 
should  it  soon  follow  the  marital  act. 

In  some  cases  I  have  found  benefit  after  a  longer  or 
shorter  continuance  of  the  Nit.  Argentum,  in  alter- 
nating with  the  Tinct.  lodini,  and  Tinct.  lodini  Com- 
positum. 

In  certain  instances  where  the  local  sensibility  was 
unusually  great,  I  have  applied  the  Acidum  Tannicum 
dry  ;  to  the  abraded  surface,  and  in  a  few  instances, 
when  used  as  a  lotion,  by  means  of  a  syringe,  a  satu- 
rated solution  of  Pulv.  Boracis,  benefit  has  resulted 
where  the  cases  seemed  previously  almost  stationary 
under  other  treatment. 

In  few  instances  I  have  used  the  Sub.  Nitrat. 
Bismuth,  applying  it  dry  to  the  diseased  portion,  but 
usually  with  benefit.  As  in  the  use  of  Acidum  Tan- 
nicum, I  have  applied  it  by  dipping  a  pledget  of  lint 
into  the  dry  powder,  and  thus  conveying  as  much  as 


SEXUAL    INTERCOURSE    NOT    INJURIOUS.  141 

possible  to  the  desired  locality.  The  Bismuth  has 
seemed  to  act  by  some  mechanical  irritation,  in  the 
same  manner,  and  perhaps  as  effectually  as  when  given 
by  the  mouth  for  dyspeptic  symptoms  or  slight 
gastritis,  but  its  effects  being  transient  and  evanescent, 
it  is  requisite  that  it  be  applied  much  oftener  than  the 
caustic,  generally  every  day  or  two. 

Frequently  it  will  be  found  useful  as  a  lotion  applied 
with  a  syringe,  the  proportion  being  as  follows. 


9.  Sub.  Nit.  Bismuth,  grs.  x. 

Aq.  Ross  I  i. 

Aq.  Pura  %  r. 
M. 


Under  these  methods  of  treatment,  the  external 
ulceration  is  easily  healed,  but  that  of  the  cavity  is  not 
so  speedily  relieved.  There  is  often  every  trace  of 
inflammatory  action,  the  redness,  congestion,  &c., 
removed,  and  yet  a  tenacious,  transparent  fluid — 
pure  albumen — exudes  from  the  orifice,  which  cannot 
be  easily  removed,  and  until  it  disappears,  your  patient 
is  not  well.  The  glands  of  the  canal  are  preter- 
naturally  excited,  and  this  flow,  although  of  a  normal 
character,  save  its  too  great  viscidity,  and  profuse 
quantity,  is  the  result  of  the  over  stimulation. 

Sexual  intercourse  I  do  not  find  necessary  to  arrest, 
as  its  temporary  natural  stimulus  seems,  when  not  too 
frequent  or  excessive,  to  unload  the  congested  glands 


142  THERAPEUTICS    OF    STERILITY. 

and  to  leave  them  in  a  condition  more  favorable  to 
complete  and  speedy  recovery. 

Benign  hypertrophy  of  the  os  uteri  is  invariably 
found  to  be  but  an  accompanying  symptom  of  internal 
cervical  disease,  and  this  phase  will  be  relieved  by  the 
treatment  above  enumerated,  one  which  will  be  found 
far  preferable,  and  fully  as  effectual  as  Lisfranc's  heroic 
treatment,  excision  of  the  neck. 

I  have  not  found  it  necessary  or  advisable  to  adopt 
the  method  proposed  by  Bennet,  of  making  an  issue  by 
caustics  upon  the  hypertrophied  cervix,  as,  theoretically, 
I  considered  by  so  doing,  I  was  treating  symptoms,  or 
at  the  best,  secondary  results,  rather  than  the  first 
prime  cause.  I  have  rather  directed  my  attention 
directly  to  the  fons  et  origo,  the  disease  of  the  interior 
cervix,  and  have  not  found  the  objectionable  issue  even 
to  facilitate  the  cure. 


Fig.  38. 


Scarifications  of  the  hypertrophied  cervix  with  a 
long  knife  are  frequently  of  marked  benefit.  For  this 
purpose  an  instrument  (Fig.  38),  with  the  blade  sliding 
through  a  shield,  is  manufactured  by  Tiemann,  which 
by  means  of  a  screw,  enables  one  to  set  the  knife  at  any 
required  length,  and  thus  to  make  the  incisions  to  any 
depth. 


LEECHES    TO    OS   UTERI.  143 

When  there  is  local  acute  congestion,  or  painful  and 
scanty  menstruation,  relief  is  not  unfrequently  found 
by  the  application  of  two  or  three  leeches  to  the 
cervix,  through  the  speculum,  care  being  taken  not  to 
allow  them  to  escape  from  the  leech-tube,  as  they 
sometimes  crawl  into  the  cavity  of  the  os,  producing 
great  uterine  disturbance,  pain,  &c.  ;  one  instance  of 
which  is  recorded  by  Dr.  I.  E.  Taylor  of  this  city. 


In  the  same  manner  that  after  a  chronic  gleet,  we 
find  urethral  stricture,  so,  after  the  subsidence  of 
chronic  leucorrhoea,  the  pathology  of  which  we  have 
endeavored  to  elucidate,  we  have  stricture  of  the  canal 
of  the  cervix.  This  stricture  is,  as  already  stated, 
located  generally  at  either  the  os  internum  or  the  os 
externum.  That  at  the  external  opening  where  its 
character  is  more  observable,  is  sometimes  apparently 
formed  by  the  effusion  and  subsequent  organization  of 
coagulable  lymph.  This  new  matter  does  not  take  on 
the  character  of  the  tissue  upon  which  it  is  located, 
but  remains  firm  and  inelastic.  Dilatation  is  effected  not 
by  any  stretching  of  the  part  but  by  its  complete  dis- 
ruption. This  is  sometimes  accomplished  in  the  par- 
oxysms of  dysmenorrlioea  and  thus  we  account  for  the 
occasional  instances  of  fissures  of  the  os  uteri  observed 
in  those  who  have  never  been  impregnated,  but  which 
in  a  former  work  {Treatise  on  Uterine  Hcemorrhage  in 


144  THERAPEUTICS    OF    STERILITY. 

all  its  Forms ^  with  some  views  respectimg  Fissures  of  the 
Os  Uteri,  as  a  frequent  cause  of  Abortion,  with  their 
Curative  Treatment),  I  have  considered  to  arise  from  an 
abortion,  and  to  be  afterward  the  efficient  cause  of  the 
frequently  repeated  premature  deliveries,  abortions  and 
miscarriages,  with  which  some  females  are  afflicted. 

Lacerations  of  the  os  and  cervix  during  labor,  are 
not  unfrequently  the  cause  of  subsequent  barrenness, 
from  causes  already  enumerated.  The  ulceration  aris- 
ing from  the  fissures  is  accompanied  by  immense 
hypertrophy  of  the  os,  and  great  leucorrhoeal  discharge. 
In  one  instance,  an  Englishwoman,  who  had  been 
treated  for  ten  or  more  years  in  England,  having  made 
many  trips  to  Bath  and  Harrowgate  and  other  springs, 
without  relief,  I  found  the  os  hypertrophied  to  a  size 
more  than  three  inches  in  diameter,  and  barely  to  be 
compassed  by  the  fully  distended  four-valved  speculum, 
with  three  extensive  rents  in  its  periphery,  and  all 
ulcerated  and  discharging  pus.  The  haemorrhage  at 
the  menstrual  period  was  frightful.  Similar  cases  I 
have  spoken  of  on  page  96. 

The  semi-transparent  whitish  lining  of  the  os  uteri 
plainly  shows  its  fibrinous  deposit,  and  the  treatment 
here  imperatively  called  for  is  incision. 

Simpson  recognizes  this  condition  as  a  cause  of 
dysmenorrhoea,  and  has  presented  an  instrument  with 
which  to  make  the  incision.  I  have  preferred  one  of  a 
simpler  construction  and  of  a  more  efficient  character. 


UTERINE    SOUNDS.  145 

It  is  a  probe-pointed  knife  with  a  short  cutting  edge 
(Fig.  39),  which  will  be  found  to  easily  divide  the 
projecting,  hard-edged  stricture,  leaving  the  other 
portion  unscathed. 

Fio.  39. 


When  this  thin  band  is  divided  in  two  or  more 
places,  a  probe  may  then  be  easily  passed  into  the 
orifice,  and  if  there  be  no  superior  disease,  may  be 
passed  into  the  cavity  of  the  uterus.  A  few  topical 
pencillings  with  lunar  caustic,  and  an  occasional 
passage  of  a  sound  through  the  opening,  and  the  cure 
is  effected.  i 

When,  however,  there  is  no  fibrinous  deposit,  the 
stricture  is  dependent  solely  upon  the  contraction  of 
the  internal  membrane,  by  the  process  of  cicatrization. 
Perhaps  the  original  disease  may  have  been  a  syphilitic 
chancre.  In  any  case,  all  that  is  present  is  a  contrac- 
tion without  the  addition,  and  probably  without  the 
subtraction,  of  any  substance.  Dilatation  is  the  remedy. 
A  probe  of  sufficient  size  should  be  passed  within  the 
small  canal  (Fig.  40),  an  ordinary  male  bougie,  and 
often  of  the  smallest  size  is  all  that  can  be  made  to 
enter  primarily.  This  is  to  be  followed  up  by  larger 
ones.     Simpson's  Uterine  Sounds,  carefully  graduated, 

10 


146 


THERAPEUTICS    OF    STERILITY. 


may  sometimes  be  effectually  used.     Similar  sounds 
may  be  made  of  gutta  percha  of  such  sizes  ks  are 


Fig.  40. 


wanted,  by  heating  the  gum  in  boiling  water,  and  will 
be  found  an  economical  substitute.  These  should  be 
passed  every  two  or  three  days,  and  allowed  to  remain 
when  entered,  for  an  hour  or  two,  or  until  their 
presence  becomes  painful. 

More  effectual  in  my  hands  have  been  the  prepared 
sponges.  These  are  made  by  taking  strips  of  fine 
sponge,  about  three  inches  in  length,  and  an  inch  more 
or  less  in  thickness,  according  to  the  size  required, 
These  are  moistened  in  water,  in  which  Gum  Acacise 
has  been  dissolved.  They  are  then  wound  closely  and 
as  firmly  as  possible  with  a  cord,  allowed  to  dry,  when- 


i 


SPONGE    TENTS. 


147 


the  cord  being  removed,  they  retain  the  shape  into 
which  they  have  been  pressed,  and  after  being  trimmed 
smooth,  are  ready  for  use. 


Fio.  41. 


Fig.  41  represents  a  tent,  to  which  a  cord  is  attached, 
into  which  a  firm  wire  (Fig.  42),  is  thrust,  with  which 
to  insert  it,  by  the  side  is  a  representation  of  the  tent 
divided  in  its  centre,  and  showing  the  cavity  into  which 
the  wire  is  passed,  to  effect  its  entrance  into  the  os. 

Preparing  the  sponge  of  the  size  and  length  appro- 
priate to  the  case,  attaching  a  piece  of  silk  to  it,  in 
order  to  favor  its  extraction,  and  the  surface  being 
carefully  oiled,  and  either  with  the  wire  (Fig.  42), 
or  seizing  it  with  a  pair  of  long  forceps,  it  should  be 
forced  into  the  cervical  canal  as  far  as  desired,  if  possi- 
ble, and  there  left  for  twenty-four  hours,  or  even 
longer,  if  it  be  not  convenient  to  insert  another  imme- 
diately :  during  which  time  the  sponge  will,  moistened 
by  the  secretions,  expand  to  its  natural  size,  and  thus 


148  THERAPEUTICS    OF    STERILITY. 

dilate  the  canal.     If  left  longer,  a  more  profuse  and 
fetid  discharge  is  excited.     Should  there  be  any  pain 


\ 


Fig.  42. 


so  as  to  render  it  necessary,  it  must  be  removed  sooner. 
Its  presence  is  not  incompatible  with  prolonged  and 
even  severe  exercise.  Indeed  I  have  repeatedly  had 
patients  ride  fifty  miles  in  the  cars,  and  return  on  the 
fourth  day  subsequently  without  any  displacement  of 
the  sponge.  The  sponge  should  be  enlarged  in  its 
diameter  as  fast  as  it  can  be,  and  until  the  canal  be 
pervious  during  its  entire  extent,  and  of  sufficient  size. 
When  once  properly  dilated,  I  have  never  known  the 
OS  to  again  contract. 

Recently,  a  proposition  of  doubtful  feasibility  has 
been  made  in  the  French  Journals,  to  dilate  the  os 
uteri,  by  passing  into  it  a  long  hollow  tube  of  india- 
rubber,  connected  by  a  tube  of  the  same  to  a  bellows  ; 
by  this  it  is  to  be  blown  up,  and  then  stopped  tight. 
From  some  experience  with  similar  instruments  in 
other  situations,  I  doubt  much  its  utility. 

Dr.  H.  R.  Storer  has  proposed  in  the  Boston  Medical 
and  Surgical  Journal,  that  tents  made  of  Elm  Bark, 
be  substituted  for  those  of  sponge,  stating  that  they 


UTERINE    SOUNDS.  149 

swell  less  rapidly  than  sponge,  and  thus  do  not  make 
such  sudden,  and,  as  he  thinks,  injuriously  rapid  dila- 
tation of  the  OS  and  cervical  canal,  and  also  from  their 
freedom  from  offensive  smell,  even  when  the  discharge 
around  is  putrid. 

During  the  continuance  of  this  method  of  treatment, 
such  vaginal  lotions  as  may  be  required  should  be  used, 
irrespective  of  this  treatment,  and  if  none  are  neces- 
sary, a  simple  bathing  in  pure  water  will  be  all  that 
will  be  required. 

When  the  stricture  is  midway,  or  affecting  the  entire 
length  of  the  canal,  or  the  os  internum,  the  treatment 
does  not  materially  differ,  except  that  it  is  proportion- 
ally longer,  the  farther  it  is  from  the  external  orifice. 

The  anatomy  of  the  interior  membrane  lining  the  os 
and  cervix  uteri,  should  be  remembered,  and  the 
manner  in  which  it  is  folded  upon  itself,  constituting 
the  arbor- vitae  appearance,  should  not  be  forgotten. 

The  passing  of  sounds  through  the  cavity  of  the 
cervix,  is  often  a  matter  of  considerable  difficulty,  and 
this  not  from  the  direct  effect  of  the  stricture,  so  much 
as  the  cervical  rugae  which  line  the  interior  surface. 
The  anatomy  of  the  interior  of  a  virgin  cervix  uteri, 
(Fig.  5),  of  the  natural  size,  will  be  sufficiently  demon- 
strated to  elucidate  this  practical  remark,  by  the 
accompanying  cuts  from  Tyler  Smith's  Leucorrhoea. 
Figs.  43  and  44,  show  the  longitudinal  and  transverse 
rugae  from  the  virgin  cervix,   magnified   respectively 


160 


THERAPEUTICS    OF    STERILITY. 


9    and   18   diameters.      These   reduplications   of    the 
mucous    membrane    lying    in    corrugated    folds,    are 


Fi«.  43. 


created  to  effect  the   dilatation   of  the   cervix   uteri 
during  labor,  without  laceration. 


DIFFICULTY   IN   PASSING   SOUNDS. 


151 


The  end  'of  the  sound  is  not  unfrequently  caught  in 
these  rugae,  and  in  the  mucous  crypts  and  sulci,  and 


Fia.  44. 


the  operator  may  perhaps  imagine  that  the  stricture 
causes  the  resistance,  which  may  be  overcome  by 
increased  pressure,  in  doing  which  he  will  run  great, 
danger  of  lacerating  the  lining  membrane,  and  of 
forming  a  false  passage,  thereby  causing  great  subse- 
quent inflammatory  difficulty. 


152 


THERAPEUTICS   OF   STERILITY. 


The  probability  of  such  an  accident  occurring  may  be 
seen  by  observing  Fig.  45,  which  is  a  side  view  of  one 


Ftg.  45. 


of  the  columns  of  rugsB  and  fosssB,  magnified  but  six 
diameters. 

Where  there  is  a  possibility  of  introducing  an  instru- 
ment through  a  firm  stricture,  dilatation  may  some- 
times be  forcibly  made,  by  gradually  separating  the 
extremities  of  an  instrument  (Fig.  46),  by  means  of  a 
screw  in  the  handle,  and  in  certain  cases  this  treatment 
will  be  found  serviceable. 

When  the  internal  os  is  the  seat  of  the  disease,  it 
is  sometimes  quite  difficult  to  pass  any  instrument 
through  it,  or  even  to  know  if  it  is  passed  through, 


CATARRH    OF   THE    WOMB.  163 

and  has  entered  into  the  cavity  of  the  uterus.  In  one 
case,  where  a  lady  from  the  interior  of  New  Jersey 
came  to  me  weekly  only,  I  was  exceedingly  troubled. 
The  affection  was  easily  recognized — the  sound  would 

Fig.  46. 


not  pass  in  more  than  a  half-inch.  A  smaller,  and 
very  fine  pointed  flexible  bougie  without  a  stylet  passed 
in,  however,  but  no  such  success  could  be  attained 
when  the  stylet  was  introduced,  or  a  large  bougie 
attempted.  Imagine  my  chagrin  when,  after  several 
attempts,  and  with  perhaps  a  trifle  more  force,  I  found 
that  the  end  of  the  bougie  was  visible,  and  that  it  was 
but  doubled  upon  itself,  and  had  not  probably  passed 
any  farther  than  the  sound.  In  this  case  it  was 
necessary  to  dilate  the  lower  portion  of  the  os,  until  it 
would  easily  admit  the  first  joint  of  the  index  finger 
before  it  had  any  effect  upon  the  internal  stricture. 

Dr.  Sims  of  New  York  recommends  in  those  cases 
of  stricture,  accompanied  by  diseased  secretions,  that  a 
metal  bougie  be  fastened  within  the  cervix,  and 
retained  therein  as  long  as  it  remains  painless,  to 
allow  the  diseased  portion  to  cicatrize  around  it.  The 
principle   does  not  differ  from  the  probe  pessary   of 


154  THERAPEUTICS    OF    STERILITY, 

Simpson,  so  ridiculed  as  the  "impaler,"  from  which, 
I  have  already  stated,  I  have  known  marked  benefits  to 
arise. 

After  the  treatment  of  the  stricture  is  finished,  the 
enlarged  condition  of  the  os  and  its  patulous  condition, 
the  discharges,  &c.,  speedily  cease,  the  os  resumes  its 
natural  appearance,  menstruation  is  eJGfected  without 
pain,  and  the  patient  feels  nothing  which  can  remind 
her  of  the  part  afi'ected. 


Catarrh  of  the  womb  is,  in  other  words,  a  chronic 
inflammation  of  its  lining  membrane,  and  generally 
accompanied  by  a  greater  or  less  co-incident  uterine 
congestion.  Its  curative  treatment  is  prolix  and  more 
uncertain  than  any  other  form  of  uterine  disease. 
Quiet — the  absence  of  sexual  excitements — the  use, 
sometimes,  of  a  mild,  alterative  treatment,  and  injec- 
tions into  the  cavity  of  the  uterus  of  solutions  of  Nitras 
Argenti  of  various  strengths,  gradually  increased  in 
potency,  have  been  the  means  usually  found  efi'ectual  in 
my  practice.  Often  the  monthly  uterine  congestion  has, 
at  its  close,  left  the  patient  apparently  no  better  than 
she  was  after  the  whole  intervening  month's  treatment. 

Occasionally  excessive  pain  follows  the  injection, 
which  I  have  relieved  in  some  cases,  by  throwing 
in  a  similar  quantity  of  olive-oil.  Metritis  is  said  to 
sometimes  occur  from  this  treatment.     I  have  never 


DILATATION    OF    THE    FALLOPIAN    TUBE. 


155 


found  actual  inflammation,  although  I  have  sometimes 
feared  it. 

I  have  heard  of  cases  where  ovaritis  followed  its 
administration,  and  the  reason  supposed,  was  that  the 
injection  had  been  in  such  quantity  and  propelled  with 
such  force,  as  to  pass  through  the  length  of  the  Fallo- 
pian tube. 

A  convenient  instrument  for  this  injection  is  a  silver 
syringe  (Fig.  47),  which  will  not  corrode,  and  is  in 
every  respect  efficient. 

Fio,  47. 


In  these  catarrhs  of  the  womb,  the  Ferrocyanuretum 
Potassii,  as  before  formularized,  I  have  found  of  much 
benefit,  the  dose  often  being  beneficially  increased  to 
double  or  quadruple  its  quantity. 


Obliteration  of  the  cavity  of  the  womb,  either 
general  or  partial,  is  with  difficulty  diagnosticated,  if 
ever  discovered,  and  even  if  its  presence  was  really 
certain,  it  could  not  be  successfully  treated.     I  have 


166 


THERAPEUTICS     OF     STERILITY. 


seen  but  one  case  only,  and  that  of  partial  obliteration, 
of  a  barren  lady  who  died  at  94,  already  referred 
to,  for  her  mental  as  well  as  physical  idiosyncracies. 

Disease  and  stricture  of  the  Fallopian  tube,  and 
especially  of  the  uterine  end,  to  which  reference  has 
already  been  made  :  theoretically  there  is  little  doubt 
of  its  existence,  but  practically,  there  is  immense 
doubt  of  the  possibility  of  recognizing  it,  save,  perhaps, 
in  some  exceedingly  rare  instances.  The  recommend- 
ation of  some  recent  English  writers,  Tyler  Smith  the 
originator,  of  passing  a  bougie  into  the  os,  and  through 

Fig.  48. 


the  cervix,  and  thence  into  the  Fallopian  tube,  and  by 
a  series  of  graduated  instruments  removing  this  stric- 
ture, in  the  same  manner  that  we  have  just  recom- 
mended for  the  OS  and  cervix  uteri,  is  itself  so  seem- 


I 


OVARIAN    DISEASE. 


167 


ingly  impossible,  that  it  has  scarcely  been  considered 
worthy  of  a  thought  by  the  profession,  and  the  professor 
himself  no  longer  urges  it  as  a  means  of  cure. 

Fig.  49  represents  another  form  of  instrument,  more 
resembling  a  catheter  ;  through  the  opening  in  the 
extremity  of  which  a  small  probe  may  be  protruded. 
These  cuts  (Figs.  48  and  49),  serve  to  show  the  many 
difficulties  which  prevent  the  successful  issue  of  this 
attempted  operation.  The  impediments  to  the  insertion 
of  a  curved  instrument  like  that  represented,  through 
the  OS  uteri  externum  and  internum  will  be  perceived 
by  observation  of  them,  and  by  reference  to  the  diffi- 
culties of  the  passage  of  uterine  sounds  stated  on 
page  151. 


Fio.  49. 


In   the  other  diseases  of  the  tube  and  fimbriated 


158  THERAPEUTICS    OF    STERILITY. 

extremity,  enumerated  in  the  pathology  of  the  disease, 
the  diagnosis,  if  possible,  is  obscure,  and  the  treatment 
must  be  of  the  most  vague  and  unsatisfactory  character. 
We  may  hope  that  nature  may  effect  some  desired 
change,  but  from  medicines  or  other  forms  of  treatment 
we  may  not  expect  any  beneficial  result. 


The  affections  of  the  ovary  bearing  upon  sterility, 
are  chronic  congestion  or  inflammation,  tumors  from 
and  of  the  organ,  and  a  peculiar  adynamic  condition 
unmarked  by  any  perceptible  alteration,  in  its  patho- 
logical character.  The  first  of  these  diseases  has  a 
pathology,  but  with  slight  and  obscure  symptoms 
evincing  it ;  the  second  is  evident  both  before  and  after 
death  ;  the  third  has  abundant  symptoms,  but  no 
pathological  alteration  in  its  tissues. 


Chronic  congestion  is  a  sequela  of  acute  inflamma- 
tory action,  and  is  superinduced  by  numerous  causes 
not  necessary  here  to  enumerate.  It  is  often  the  result 
of  interrupted  menstruation,  and  is  to  be  met  by  local 
antiphlogistic  treatment ;  leeches  to  the  abdominal 
region  adjoining,  sometimes,  and  particularly  if  any 
sympathy  exist,  to  the  os  uteri ;  and  a  very  mild  altera- 
tive course.  Especially  is  a  loose  condition  of  the 
bowels  important,  and  an  aloetic  daily  pill  will  be  found 


LOCAL    STIMULATION.  159 

an  important  adjunct  to  such  other  treatment  as  may 
be  necessary. 


If  the  theory  enunciated  as  to  the  manner  in  which 
a  superabundance  of  fat  prevents  conception,  be  true, 
then  the  only  method  of  accomplishing  the  desired  end, 
is  to  reduce  the  plethora.  If,  however,  the  fat  is  but 
a  result  of  the  cessation  of  the  functions  of  the  ovary, 
from  a  failure  in  the  evolution  of  the  Graafian  vesicle, 
topical  stimulants  are  to  be  resorted  to,  and  by  no 
medicines  have  such  beneficial  results  been  attained,  as 
by  the  internal  administration  of  the  Cantharis.  This 
may  be  given  in  pill,  powder,  or  tincture,  beginning 
with  small  doses,  and  gradually  increasing  until  its 
specific  effects  upon  the  mucous  passages  are  plainly 
perceptible.  The  following  formula  may  sometimes  be 
found  serviceable,  where  general  stimulation  is  con- 
sidered advisable  : 


9 

.  Puly.  Capsici 

588. 

"     Zinziberis 

5  189. 

"     Cantharidis 

31188. 

Croci 

3188. 

Pulv.  Caryophili 

588. 

Alcohol. 

Oiiiss. 
M. 

Dose 

3  S8  to  3  iii- 

The  administration  of  Cantharides  is  indeed  empirical, 
for  it  is  given  without  a  due  knowledge  of  the  existing 


160  THERAPEUTICS    OF    STERILITY. 

condition,  and  also  without  an  adequate  idea  of  its 
method  of  action.  It  is  presumed,  however,  that  it 
stimulates,  and  even  produces  inflammatory  action  in 
the  mucous  passages  of  the  kidneys,  the  uterus,  the 
bladder,  urethra,  and  the  intestinal  tract  to  some 
degree,  and  that  the  uterus  and  its  appendages  sympa- 
thize in  this  excitation,  and  the  sluggish  ovaries  are 
provoked  to  new  and  vigorous  action.  Certain  it  is, 
however,  that  in  many  cases  where  no  local  or  general 
disease  is  manifest,  and  yet  where  sterility  is  present, 
the  administration  of  this  medicine,  is  not  unfrequently 
followed  by  pregnancy. 

Dr.  Mackenzie  before  the  Med.  Society  of  London, 
recently  recommended  Amorphous  Phosphorus  in  cer- 
tain affections  of  the  uterine  organs,  attended  with 
weakness  and  irritability  of  the  nervous  system — to  be 
given  in  doses  from  10  to  30  grains  diffused  in  water. 
It  appears  to  act  as  a  direct  tonic  or  stimulant  to  the 
uterine  system.  He  had  known  pregnancy  to  super- 
vene upon  its  employment,  after  a  lengthened  period 
of  sterility,  subsequent  to  marriage. 


Raisers  of  stock  have  noted  that  high-conditioned 
mares  and  fat  cattle  do  not  readily  breed,  and  they  are 
in  the  habit  of  reducing  the  animal  by  copious  bleedings 
and  purges,  before  the  male  is  admitted,  and,  thus  pre- 
viously treated,  the  desired  end  is  obtained.    In  several 


ELECTRICITY   AND    GALVANISM.  161 

instances  where,  acting  upon  this  hint  from  the  stables, 
a  copious  bleeding  and  free  purgation  followed  the 
menstrual  period,  accompanied  by  a  season  of  dietetic 
attention,  conception  has  resulted,  which  had  failed  to 
be  effected  during  many  previous  years  of  married 
life.  ^ 


The  application  of  electricity  is  sometimes  of  benefit 
in  arousing  the  reproductive  organs  to  their  natural 
action.  M.  Roubaud  in  his  recent  work,  states  that  he 
has  had  a  greater  success  than  most  in  the  treatment 
of  cases  that  I  am  now  describing,  where  no  disease  is 
apparent.  Indeed,  he  claims  that  in  6  out  of  10  cases, 
particularly  in  those  whose  sterility  proceeds  from 
sexual  abuse  in  prostitution,  this  treatment  is  followed 
by  childbirth.  The  application  is  made  once  or  twice  a 
week  for  several  months,  during  which  time  coition  is 
suspended,  and  great  simplicity  and  regularity  in  all 
the  details  of  life  are  to  be  rigorously  exacted. 


In  those  cases  where  there  is  reason  to  suspect  that 
the  female  may  be  tainted  by  syphilis,  it  will  be  found 
necessary  to  premise  all  other  treatment  by  a  constitu- 
tional course,  and  almost  without  exception,  a  cautious 
and  protracted   administration  of  mercurials  wilt  be 

11 


162  •  THERAPEUTICS    OF    STERILITY. 

found  advisable.  Those  mixed  with  Iodine  in  minute 
doses,  I  have  found  most  serviceable.  Particularly 
have  I  been  pleased  with  the  following  preparation  : 

5.  Chloridi  Auri  grs.  v. 

Hydrarg.  Chlor.  Corrosiv.  grs.  L 

Amyli.  3  ii. 

Gum  Acacise  Pulv.  3  ss. 

M. 
Et  diy  in  pil.  no.  LX. 

Una  ter  in  die. 

Finally,  infrequent  coitus,  and  especially  at  seasons 
following  soon  after  the  disappearance  of  the  menses, 
will  be  found  important. 

Conception  is  prevented  and  pregnancy  interrupted 
by  excessive  intercourse  with  the  married  as  with  the 
courtezan,  and  if  not  so  generally,  at  least,  with  suffi- 
cient frequency  as  to  be  noted  and  guarded  against. 
The  uterus,  when  too  much  excited,  becomes  irritable, 
and  expels  its  contents.  In  animals  it  is  noticed,  and 
graziers  are  in  the  habit  of  throwing  cold  water  over 
their  brood  mares  and  kine  who  are  generally  sterile, 
with  beneficial  results. 

Pure  air,  qufetude  of  mind,  temperance  in  food, 
drink,  and  sleep — whatever  conduces  to  general  health 
and  regularity  of  life,  will  be  found  advantageous,  in 
conjunction  with  all  medicines,  and  every  variety  of 
treatment.  The  cultivation  of  correct  habits  of  mind 
and  body  can  do  no  harm.     They  may  not  have  the 


BENEFICIAL     RESULTS.  163 

desired  result  which  is  the  object  of  these  pages,  but 
they  will  assist  in  cultivating  a  frame  of  mind  and 
temper  of  spirit  that  will  render  the  inevitable  and 
incurable  ill  easier  to  be  borne,  and  perhaps  less 
regretted. 


THE   END. 


I 


AUTHORITIES 

REFERRED  TO  AND  QUOTED  IN  THIS  BOOK. 


Manual  of  Human  Microscopical  Anatomy,  by  A.  KoUiker,  Prof,  of 
Anat.  and  Phys.,  Wiirsburg,  Edited  by  J.  Da  Costa,  M.  D. 

Practical  Treatise  on  Inflammation  of  the  Uterus,  its  Cervix  and 
Appendages,  by  James  H.  Bennet,  M.  D. 

The  Cause  and  Treatment  of  Abortion  and  Sterility,  by  James 
Whitehead,  M.  D. 

An  Inquiry  into  the  Pathological  Importance  of  Ulceration  of  the  Os 
Uteri,  by  Charles  West,  M.  D. 

The  Pathology  and  Treatment  of  Leucorrhoea,  W.  Tyler  Smith,  M.  D. 

Traite  de  I'Irapuissance  et  de  la  Sterilite  chez  I'Homme,  et  chez  la 
Femme,  par  le  Docteur  Felix  Roubaud,  Paris,  1855. 

The  Philosophy  of  Marriage,  by  Michael  Ryan,  M.  D. 

Clinical  Reports  of  Ovarian  and  Uterine  Diseases,  by  Robert 
Lee,  M.  D.,  London,  1853. 

The  Writings  of  Hippocrates  and  Galen,  by  John  Redman 
Coxe,  M.  D. 

A  Practical  Treatise  on  Diseases  of  the  Uterus  aud  its  Appendages, 
by  Mme.  Veuve  Boivin. 

The  Philosophy  of  Reproduction,  by  R.  J.  Mann,  M.  D.,  London,  1856. 

On  some  Diseases  of  Women,  admitting  of  Surgical  Treatment,  by 
Isaac  Baker  Brown,  F.  R.  C.  S.,  London,  1856. 

Report  on  the  Acute  and  Chronic  Diseases  of  the  Neck  of  the 
Uterus,  by  Charles  D.  Meigs,  M.D.,  of  Philadelphia,  to  the  Am.  Med. 

165 


166  AUTHORiriE?. 

Association.  (From  which,  by  the  kind  permission  of  its  distinguished 
author,  I  have  borrowed  Plate  III.,  and  Fig.  1  of  Plate  V.) 

The  Cell,  its  Physiology,  Pathology,  and  Philosophy,  by  Waldo  J. 
Burnett,  M.  D.,  prize  Essay  of  the  Am.  Med.  Association. 

Obstetric  Memoirs  and  Contributions  of  James  N.  Simpson,"  M.  D., 
F.  R.  S.  E.     Edited  by  W.  Priestly,  M.  D.,  H.  R.  Storer,  M.  D.,  vol.  1. 

Traits  Complet  de  I'Art  des  Accouchements,  par  M.  Paul  Antoine 
Dubois.     Tome  premier.     Paris,  1849. 

Maladies  de  I'Uterus,  d'apres  les  le9ons  Cliniques  de  M.  Lisfranc, 
faites  a  I'Hopital  de  la  Pitie,  par  M.  Pauley,  Paris,  1856. 

Mondat  on  Sterility, 

M6moire  sur  les  Ulcerations  du  Col  de  la  Matrice  Ac,  Revue  Medi- 
cale,  1857,  1855,  par  Camille  Melchior  Gibert. 

Traite  de  I'Ecrasement  Lineaire,  &c.,  par  M.  E.  Chassaignac,  Paris, 
1856. 

Die  Galvanocaustik  ein  Beitrag  zur  Operativen  Medicin,  von  Dr. 
A.  T.  Middeldorpf,  Breslau,  1854,  and  On  Cauterization  by  Galvanism, 
by  Algernon  CooUdge,  M.  D.,  Boston  Med.  and  Surg.  Jour,  Nov.  1855. 


INDEX. 


Abortion,  112. 
Acid,  nitric,  use  of,  122. 
"     Hydrarg.  nit.,  use  of,  189. 
"     Tannic,  use  of,  140. 
Age  of  those  capable  of  fecundation,  115. 
"    cause  of  sterility  and  impotence,  59. 
Albumen  from  cavity  of  the  os,  90. 
Anaesthesia,  local,  121. 
Anatomy,  comparative,  9. 
"         of  the  egg,  31. 
"  "     canal  of  the  uterus,  24. 

"  "      uterus,  23. 

Amorousness,  periodical,  11. 


B. 


Births,  proportion  of  male  to  female,  21. 
Bismuth,  140. 
Bleedings,  160. 
Borax,  140. 


a 


Cantharides,  158. 

Carbonic  acid  gas,  122. 

Caustics,  their  variety  and  relative  Talue, 
139. 

Cautery,  actual,  132. 

Cell,  theory  of  growth   and   reproduc- 
tion, 33. 
*'    in  yeast,  36 

Cervix,  cartilaginous,  97. 

Chloroform,  use  of,  121. 

Conception,  time  of,  in  woman,  16-32. 
"  tendencv  to,  in  the  phthisi- 

cal, 77. 


D. 

Decidua,  29. 

"       when  destroyed,  16. 
Diagnosis,  rtiost  certain  in  the  young,  77. 
Dysmenorrhoea,  29-96. 


E. 


Economy  of  nature,  0. 
Ecrasseur,  132. 
Egg  of  birds,  28-31. 

"      "  fish,  14. 

"      "  woman,  28. 

"    anatomy  of,  31. 

"    passage  of,  29. 
Electricity,  160. 
Ergot,  132. 
Examination,  physical,  when  necessary, 

81. 
Exzema  of  os  uteri,  76. 


F. 


Fallopian  tube,  22-52-99. 

"  "     inflammation  of,  99. 

"         obliteration  of,  99. 
"        polypi  in,  101. 
"  •       stricture  of,  99. 
"  "         "  treatment,  156. 

False  membrane,  97. 
Fatness,  influence  of,  105. 

"        theory  concerning,  106. 
"        treatment  of,  158. 
Fecundation  in  plants,  14. 
"  "  fish,  15. 

"  how  ensured,  58. 

"  not  incompatible  with  ulcer- 

ations, 89. 


168 


INDEX. 


Fecundation,  tendency  to  in  the  scrofu- 
lous, 76. 

Fimbriated  extremity,  inflammation  of, 
100. 
"  "       deformity    of,  100. 

"  "      misplacement,  luO. 

Forceps  polypus,  128. 

Frigidity,  48-111. 

Free-martins,  107. 


Galvanism,  184. 

Genitals,  secretions  from  female,  32. 
Gleet  a  cause  of  sterility,  59. 
Gonorrhoea  a  cause  of  sterility,  59. 


Hydatids,  uterine,  72. 

"  "       removal  of,  137. 

Hymen,  varieties  of,  60. 
"       imperforate,  61. 
"        treatment  of,  117. 
"        small  orifice  in,  61. 
"  "        "        "  division  of,  117. 

"        unusually  strong,  61. 
"        removal  of,  118. 
Hypertrophy  of  uterus,  96. 
"  "   OS  uteri,  96. 

"  "         "      treatment    of, 

142-144. 


I. 

Impotence,  59. 

Impregnation,  seasons  of  in  animals,  1 6. 
"  "         "       women,  16. 

Inflammation  of  os  and  cervix,  75. 
Iodine,  140. 


Labia,  adhesions  of,  60. 
Leeches  to  os  uteri,  143-158. 

"  "         "     danger  from,  143. 

Leucorrhoea,  79. 

"  its  hereditary  tendency,  89. 

"  character  of  os  in,  95. 

Leucorrhoeal  discharges,  60. 
Lichen  of  os  uteri,  76. 
Ligatures,  varieties,  122. 

"         of  silver  wire,  128. 
Lotions,  140. 


M. 


Man  in  his  first  estate,  37. 
Masturbation,  111. 
Menstruation  in  animals,  17. 

"  character  of,  27. 

"  without  external  evidence, 

28, 
Mercurialization,  its  effects,  59-112. 


N. 


Neuralgia  of  the  uterus,  104. 

"  "  "   treated  by  chloro- 

form, &c.,  120. 


0. 


Os  uteri,  abrasions  of,  85. 
"      "      anatomy  of,  23. 
"      "      excisions  of,  142. 
"      "      fissures  of,  9'0-l43. 
"      "      issues  upon,  142. 
"      "      strictures  of,  143. 
Ovary,  30-103. 

"      acute  inflammation  of,  103. 
"      chronic  inflammation  of,  104. 
"      atrophy  of,  1U3. 
"      malformations,  103. 
"      passage  to  and  from  vagina,  50. 
Ovisacs,  29-39. 
Ovulse  nabothii,  72. 
Ovum,  its  character,  21. 

"      passage  through  Fallopian  tubes, 
66. 


Passion,  venereal,  absent,  49. 

"  "         excessive.  111. 

Peculiarities,  mental,  109. 
Penis,  its  magnitude  a  cause  of  barren- 
ness, 58. 

"       "  "  a  cause  of  divorce,  58. 

Phosphorous,  160. 
Phthisis,     developed    by    uterine     dis 

ease,  89. 
Pinguidity,  105. 
Polypi  of  uterus,  69. 

"      vesiciilar,  70. 

»      of  Fallopian  tube,  101. 

"      removed  by  ligature,  128. 

««  "         "  forceps,  128. 

««  .  "         "  caustics,  130. 


INDEX. 


169 


Polypi  removed  by  curette,    130. 

"  '•        "  excision,  132. 

"  "         "  galvanism,  134. 

"  "         "  ecrasseur,  184. 

"      little  haemorrhage  from  excision 
of,  132. 
Potassa  fusa,  139. 

"       cum  calce,  139. 

"       ferrocyanuretum,  189. 
Precocity  of  dftvelopraent,  116. 
Pregnancy  period,  if  possible,  116. 


Raspberry  os,  84^88. 

Rectum,  tumors  in,  65. 

Reproduction,  in  what  it  consists,  14. 

Rickets,  120. 

Rheumatism  of  uterus,  104. 


S. 


Scarifications  of  os,  142. 
Scrofula,  evidenced  by  uterine  suscepti- 
bilities, 77. 
Secretions  of  female  genital  organs,  32. 
Sexes,  distinct  in  all  nature,  14. 
"      produced  at  will,  19. 
"      proportion  of  the,  21. 
Sexual  intercourse,  inordinate,  94. 
"      appetites,  absence  of,  49. 
"      intercourse  not  contraindicated, 

141. 
"  "  excessive.  111. 

Skin,  diseases  of,  analogued  on  cervix 

uteri,  75. 
Sounds,  uterine,  145. 

"  "  difficulty  in  using,  151-168. 

Speculum,  new  form,  138. 

"  treatment  with,  138. 

"         value  of,  74. 
"  of  OS  uteri,  92. 

Sperm,  40. 
Speimatozoa,  41. 

"  top  of,  44. 

"  possessing  instinct,  49. 

"  activity  commences,  47. 

"  entering  ovum,  47-53. 

"  how  destroyed,  81. 

Spermatic  filament,  43. 

"         fluid,  composition,  40. 
"  "     without  spermatozoa,  95. 

Sponge  Tents,  146. 
Sterile,  peculiarities  of  the,  109. 
"       proportion  of,  21. 


Stricture  of  Fallopian  tube.",  99. 

"         "  "  treatment,  165. 

"         "  08  uteri,  96. 

"         "        "        treatment,  146. 

"        "         vagina,  64. 

"        "  "      treatment,  120. 

Supporter,  uterine,  124. 
Syphilis,  its  effects,  69. 
Syphilization,  111. 

"  treatment,  161. 

Syringe,  uterine,  166. 


Tumors  in  Fallopian  tubes,  102. 

"        "   abdomen,  102. 

"        "    urethra,  121. 

"       removed  by  ligature,  122. 

"  "        by  knife,  122. 

"  "        by  caustic,  122. 

Twin  birth,  female  sterile,  107. 


V. 


Ulcerations  of  os  and  cervix,  83. 

"  "  "  treated,  187. 

Uterus,  anatomy  of,  23. 

"      absence  of,  109. 

"  "         "    canal,  24. 

"       muscular  character  of  neck,  26. 

"       malposition  of,  64. 

"       ulceration  of  cervix,  88. 

"       laceration  "       "      96. 

"       prolapsus,  64. 

"       flexions  and  versions,  67. 

"       hypertrophy  of,  64. 

"       falling  of,  64,  82. 

"       ossified,  98. 

"       obliteration  of  cavity,  166. 

"       catarrh  of,  164. 

"      injections  into  cavity,  154. 

"       pain  relieved  by  anaesthetics,  121. 

"      secretions  from,  80. 

"       disease  of,  78. 

"  *'       symptoms,  78. 

"       stricture  of  os,  96. 

"      mouth  of,  opens  at  congress,  48. 

"  "  "         menstruation,  48. 

Utricle,  primordial,  36. 


Vagina,  passage  from,  to  ovary,  60. 
"        aucietious  of,  80. 


170 


INDEX. 


Vagina,  malformation  of,  66. 

"       inflammation  of,  120. 

"       absence  of,  60. 

"       obliteration  of,  59. 

"        contractions  of,  62. 

"       stricture  from  wounds,  63. 

««  »'  "      labor,  64. 

«'  "         treatment,  120. 

"       sensitiveness  of,  120. 
Versions,  character  of,  67. 

"         treatment  of,  123. 
Vesicles,  33.  ' 

"         a  type  of  vitality,  84. 
"         fissiparous,  36. 

"         gemmiparous,  36. 


Vesicles,  germinating,  34. 

"         fertilizing,  41. 

"         subdivided,  38. 

"        union  of  germinating  and  fer- 
tilizing, 53. 

"         duties  of,  57. 
Villi,  enlarged,  87. 
Virility  at  advanced  age,  59. 


W. 


Wolfian  bodies,  51. 
Womb.     See  Uterus. 


I 


De  Witt  &  Davenport  with  pleasure  aunouuce  that  they  have  in 
press  and  will  issue  as  sooa  as  possible  a  work  by  the  author  of  Steri- 
lity, entitled  : 

ABORTION    AND    MISCARRIAGE. 

THEIB   CAUSES,    EFFECTS    UPON   THE    CONSTrTUTION,    AND    METHODS    OF 
ARRESTING, 

With  Woodcuts  and  Colored  Lithographs. 

This  work  will  be  issued,  in  paper,  typography  and  illustration  in 
all  respects  equal  to  the  present  work.  The  author  having  devoted 
much  time  and  thought  to  this  subject — one  of  great  importance  and 
heretofore  but  imperfectly  treated  upon  in  American  medical  literature — 
it  is  confidently  expected  that  a  large  edition  will  be  required.  Orders 
from  physicians  and  others,  for  single  copies,  remitting  the  retail  price 
(for  which  see  future  announc'ements),  will  be  early  supplied  through 
the  mail,  postage  paid. 


The  Publishers  have  also  to  announce  the  speedy  publication  of 

W.  TYLER  SMITH'S  NEW  WORK 

ON     OBSTETRICS, 

now  in  course  of  publication  in  London.     The  work  will  be  issued  as 
soon  as  possible  after  its  completion,  and  will,  in  mechanical  execution, 
compare  most  favorably  with  the  English  edition.     It  will  constitute 
a  volume  of  about  400  pages  with  two  hundred  Wood-cut  Illustrations, 
forming  the  most  valuable  and  most  fully  illustrated  work  upon  this 
subject  ever  published  in  any  language.     The  completed  portion  evinces 
a  niceness  of  description  and  an  accuracy  in  detail  that  will  commend 
it  to  every  educated  physician.     Not  only  is  it  a  clear  and  logical 
work  for  the  student,  but  its  originality,  its  able  resume  of  the  most 
modern  views  upon  every  branch  of  practical  obstetricy,  such  as  the  use 
of  anaesthetics,  the  treatment  of  placenta  prsevia,  of  puerperal  convul- 
sions ;  together  with  the  collateral  branches  of  the  microscopical  appear- 
ance in  the  growth  of  the  foetus,  in  the  changes  in  the  uterus,  the  pla- 
centa, the  mamma  &c.  (comprising  the  accepted  views  of  Lee,  Simp- 
son,   Murphy,    Dubois,    Cazeaux,    Chailly,    Coste,    Channing,    Meigs, 
Francis),  will  render  it  the  most  comprehensive  work  extant  and  one 
eminently  worthy  of  the  attention  of  old  practitioners  of  medicine,  and 
indeed  of  all  who  wish  to  be  "  up  "  to  the  most  modem  views  of  the  day. 
In  order  to  render  the  work  still  more  complete,  the  Publishers 
have  engaged  Dr.  A.  K.  Gardner  to  undertake  the  editorial  supervision 
of  the  volume,  who  will  enrich  it  with  notes,  emendations,  and  additional 
illustrations,  both  wood-cut  and  colored  lithographs,  drawn  from  his 
extensive  personal  experience. 


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Gardner,  Augustus  K 

Causes  and  curative  treatment 
of  stCTJlity. 


WP570 
G226c 

1856 
Gardner,  Augustus  K 

Causes  and  curative  treatment  of 
sterility . 


MEDICAL  SCIENCES  LIBRARY 

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